‘Simple’ risk score prognostic of stroke in patients with HFpEF but no atrial fibrillation
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Key takeaways:
- A novel risk model can predict stroke in patients with HF with preserved ejection fraction without atrial fibrillation.
- Risk scoring was based on history of stroke, insulin-treated diabetes and NT-proBNP level.
Researchers reported a novel risk model for predicting stroke risk in patients with HF with preserved ejection fraction without atrial fibrillation demonstrated “good” discrimination in an analysis of two large, pooled cohorts.
Patients with HFpEF without AF in the highest tertile of risk as determined by the risk model experienced similar stroke occurrence compared with patients with AF, according to the study published in Circulation: Heart Failure.
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“Stroke commonly occurs in patients with HF and reduced EF, even in individuals without AF. Less is known about the occurrence of stroke in patients with HFpEF, especially those without AF,” Toru Kondo, MD, PhD, research fellow in cardiovascular and metabolic health at the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, and the department of cardiology at Nagoya University Graduate School of Medicine, Japan, and colleagues wrote. “The purpose of this study was to describe the rate of occurrence of stroke in patients with HFpEF and to validate our stroke prediction model as well as S2I2N0-3 score, which is a more simple prediction score developed from our stroke prediction model for a clinical purpose, in patients with HFpEF without AF, using this large, pooled dataset.”
For this study, Kondo and colleagues validated a risk prediction model for stroke among 8,924 patients with HFrEF in the I-Preserve and PARAGON-HF trials that consisted of three variables: history of stroke, insulin-treated diabetes and N-terminal pro-B-type natriuretic peptide level.
Participants were classified by tertiles based on their risk score.
Overall, 42.6% of participants had AF at baseline and the reminder did not (mean age, 71 years; 85.4% white; 58.4% women).
The researchers observed that 3.7% of patients without AF experienced a stroke during median follow-up of 3.6 years, translating to a rate of 10.5 per 1,000 patient-years, and risk for stroke increased with the risk score (HR for second tertile vs. first = 1.78; 95% CI, 1.17-2.71; HR for third tertile vs. first = 3.03; 95% CI, 2.06-4.47).
Kondo and colleagues reported a stroke occurrence rate of 17.7 per 1,000 patient-years among those without AF in the third tertile.
This occurrence rate was similar compared with patients with AF not taking anticoagulants (20.7 per 1,000 patient-years) and those with AF on anticoagulants (14.5 per 1,000 patient-years), according to the study.
Moreover, Kondo and colleagues reported good discrimination with the present model with a C index of 0.81 (95% CI, 0.68-0.91).
“This risk model reliably identified a subset of patients with heart failure and preserved ejection fraction without atrial fibrillation at a high risk of stroke. The model can be converted to a simple score (S2I2N0-3) convenient for clinical use,” the researchers wrote. “Patients at high risk of stroke may have a risk-benefit balance that justifies the use of prophylactic anticoagulation, although this needs to be tested prospectively in a clinical trial.”
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