Increased Stroke Risk in Atrial Fibrillation Patients With Heart Failure

See related article, p 667.Stroke is a devastating complication of atrial fibrillation (AF), causing substantially greater neurological deficit than strokes in non-AF patients, as well as longer hospital admission, higher rates of death, and reduced ability to function independently. The risk of stroke in AF is not homogeneous and is closely associated with common patient characteristics, as summarized by the CHA2DS2-VASc score, which incorporates heart failure, hypertension, age, diabetes mellitus, female sex, prior stroke or embolic events, and vascular disease.1In patients with AF, heart failure has been strongly associated with increased stroke/thromboembolism and mortality and independently adds to risk prediction of outcomes.2 Congestive heart failure is represented by the C criterion in the CHA2DS2-VASc score to represent the higher stroke risk associated with recent decompensated heart failure irrespective of ejection fraction (thus including heart failure with reduced ejection fraction [HFrEF] and heart failure with preserved ejection fraction [HFpEF]), as well as moderate-severe left ventricular systolic impairment on echocardiography.1 This is in contrast to …