Abstract 12503: Both Heart Failure With Reduced and Preserved Ejection Fraction Should Be Included in the CHA 2 DS 2 -VASc Score: A Taiwanese Longitudinal Cohort

Abstract

Background: Congestive heart failure (CHF) is a known risk factor for atrial fibrillation (AF)-related thromboembolic stroke. The CHA2DS2-VASc score incorporates CHF but was developed when it primarily referred to patients with reduced ejection fraction (HFrEF). CHF now includes preserved ejection fraction (HFpEF) patients. Therefore, the distinction between stroke risk of AF patients with HFpEF and HFrEF is important for improving risk assessment and management strategies for AF patients. Methods: In a longitudinal study utilizing the National Taiwan University Hospital Integrated Medical Database (iMED), 8358 patients with atrial fibrillation (AF) were followed from January 2010 to December 2020 (mean follow-up 3.76 years). Among these patients, 4654 (55.7%) had no history of CHF, 2374 (28.4%) had HFpEF, and 1330 (15.9%) had HFrEF. HFpEF was defined as patients with a left ventricular ejection fraction (LVEF) of 55% or higher. The study evaluated the risk of ischemic stroke using Cox models adjusted for all components of the CHA2DS2-VASc score. Results: Patients with HFpEF were older, more frequently female, and had a higher prevalence of previous stroke and hypertension. They also had a higher mean CHA2DS2-VASc score (4.08±1.502 vs. 3.83±1.571, p<0.001) and a higher risk of stroke compared to HFrEF patients (30.1% vs 26.3%, p=0.014). After adjusting for other stroke risk factors with CHA2DS2-VASc score components, there was no significant difference in the risk of stroke between the HFpEF and HFrEF groups (p=0.799). Conclusion: Both HFpEF and HFrEF were associated with a higher risk of stroke. Thus, the criteria of "CHF" in the CHA2DS2-VASc score should include HFpEF as well.