Some Heart Failure Patients Without AFib May Benefit From Anticoagulation

Line Melgaard MSc. Industrial Medicine, PhD student AALBORG Univerity Hospital Thrombosis Research Center Aalborg Aalborg Hospital Science and Innovation Center Aalborg DenmarkMedicalResearch.com Interview with:
Line Melgaard MSc. Industrial Medicine, PhD student
AALBORG Univerity Hospital
Thrombosis Research Center Aalborg
Aalborg Hospital Science and Innovation Center
Aalborg Denmark

Medical Research: What is the background for this study? What are the main findings?

Response: In recent years, use of the CHA2DS2-VASc score in predicting ischemic stroke, thromboembolism, and death has extended beyond the original disease state (atrial fibrillation) for which it was proposed. In addition, it is recognized that the cluster of multiple stroke risk factors included within the CHA2DS2-VASc score increases the risk of ischemic stroke, thromboembolism, and death, whether or not atrial fibrillation is present. Thus, there is a need to study the extent to which concomitant atrial fibrillation modifies the pattern of the association between CHA2DS2-VASc score and the risk of ischemic stroke, thromboembolism, and death in patients with heart failure.

  • Our principal findings were that patients with heart failure had a high risk of ischemic stroke, thromboembolism, and death, whether or not atrial fibrillation was present.
  • Second, the CHA2DS2-VASc score was able to modestly predict these endpoints, and had a moderately high negative predictive value at 1-year follow-up.
  • Third, at high CHA2DS2-VASc scores (≥4), patients with heart failure without atrial fibrillation had high absolute risk of ischemic stroke, thromboembolism, and death, and the absolute risk increased in a comparable manner in patients with heart failure with and without atrial fibrillation, exhibiting a clear dose-response relationship. Indeed, the absolute risk of thromboembolic complications was higher among patients without atrial fibrillation compared to patients with concomitant atrial fibrillation at high CHA2DS2-VASc score (≥4).

Medical Research: What should clinicians and patients take away from your report?

Response: In the general atrial fibrillation population, a stroke risk of >1%/year is often used as a cutpoint to identify patients in whom the benefits of long-term oral anticoagulation may outweigh the risks of bleeding. In the present heart failure population, patients without atrial fibrillation with a CHA2DS2-VASc score ≥2 had a stroke risk of >1%/year. Although it is not clear whether this cutpoint would apply directly to the heart failure population without atrial fibrillation, our results may suggest that subgroups of patients with heart failure without atrial fibrillation and with ≥2 components of the CHA2DS2-VASc score beside heart failure are at high enough risk of ischemic stroke to benefit from anticoagulation therapy; especially with availability of the non-vitamin K antagonist oral anticoagulants (NOACs).

Medical Research: What recommendations do you have for future research as a result of this study?

Response:   The poor prognosis of atrial fibrillation for ischemic stroke and death in patients with heart failure was evident in our study, but the observation that additional risk factors in patients with heart failure are particularly significant among those without atrial fibrillation is an important result. Indeed, preventative strategies to reduce ischemic stroke and thromboembolic risk in this large patient population require further investigation.

Furthermore, although these initial results demonstrate a potential use of the CHA2DS2-VASc score, the direct clinical utility of stroke risk stratification in patients with heart failure is still an open question.

Citation:

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MedicalResearch.com Interview with:, & Line Melgaard MSc (2015). Some Heart Failure Patients Without AFib May Benefit From Anticoagulation 

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