title: Impact of heart failure with normal ejection fraction on the occurrence of ischaemic stroke in patients with atrial fibrillation.
abstract: OBJECTIVE
  The purpose of this study is to examine the risk of stroke in patients with heart failure with normal ejection fraction (HFNEF) and atrial fibrillation (AF).
  
  
  METHODS
  Clinical and echocardiographic data in patients with non-valvular AF who were not on anticoagulation were retrospectively investigated. A total of 304 patients had AF without heart failure, and 102 patients were diagnosed as AF with HFNEF.
  
  
  METHODS
  We compared the rate of ischaemic stroke, death and composite of these in the two groups.
  
  
  RESULTS
  Patients with AF and HFNEF were older than those with AF only (71.6 vs 64.0 years, p<0.001). Female sex, diabetes mellitus, hypertension, chronic kidney disease, angina, myocardial infarction, use of β blocker or digoxin were more common in patients with AF and HFNEF. The rates of ischaemic stroke, death and composite of ischaemic stroke and death were higher in patients with AF and HFNEF than in those with AF only (20.6% vs 6.7%, p<0.001; 27.2% vs 2.0%, p<0.001; 41.2% vs 8.1%, p<0.001 at 3 years for AF with HFNEF vs AF only, respectively). After adjustment with propensity score method using the inverse probability of treatment weighting, the 3-year risks of for ischaemic stroke (HR 3.29; 95% CI 1.58 to 6.86; p=0.001), death (HR 5.52; 95% CI 2.24 to 13.63; p<0.001), and composite of ischaemic stroke and death (HR 4.08; 95% CI 2.30 to 7.26; p<0.001) were significantly higher in patients with AF and HFNEF.
  
  
  CONCLUSIONS
  HFNEF is associated with an increased risk of stroke and death in patients with AF.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Sun-Joo
authors.initials: SJ
authors.lastname: Jang
authors.forename: Min-Seok
authors.initials: MS
authors.lastname: Kim
authors.forename: Hee-Jung
authors.initials: HJ
authors.lastname: Park
authors.forename: Seungbong
authors.initials: S
authors.lastname: Han
authors.forename: Duk-Hyun
authors.initials: DH
authors.lastname: Kang
authors.forename: Jae-Kwan
authors.initials: JK
authors.lastname: Song
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
authors.forename: Jae-Joong
authors.initials: JJ
authors.lastname: Kim
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D002545:Brain Ischemia / Q000453:epidemiology* / Q000209:etiology; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate / Q000639:trends