| アブストラクト | BACKGROUND: Heart failure (HF) is a risk factor for stroke among people with atrial fibrillation (AF). Prognosis following a HF diagnosis is often poor, but this is not accounted for in existing stroke risk scores. AIM: To examine stroke incidence in people with HF and AF compared to AF alone, considering the competing risk of death. DESIGN AND SETTING: Population-based cohort study. METHODS: We identified 2,381,941 people aged >/=45 years in the Clinical Practice Research Datalink (2000-2018). HF and AF were included as time-varying covariates; 69,575 had HF and AF, 141,562 had AF alone and 91,852 had HF alone. We report hazard ratios for first stroke using Cox and Fine and Gray models. RESULTS: Over median follow-up of 6.62 years, 93,665 people (3.9%) had a first stroke and 314,042 (13.2%) died. Over half (51.3%) of those with HF and AF died. In the fully-adjusted Cox model, relative stroke risk was highest among people with AF alone (HR 2.43, 95%CI: 2.38-2.48) than HF and AF (HR 2.20, 95%CI: 2.14-2.26). In a Fine and Gray model accounting for all-cause mortality, the relative risk of stroke was similar for people with AF alone (HR 2.38, 95%CI: 2.33-2.43), but there was significant attenuation among those with HF and AF (HR 1.48, 95%CI: 1.44-1.53). CONCLUSION: HF is an aetiological risk factor for stroke yet its prognostic significance is reduced by the high incidence of death. Use of the CHA2DS2VASc score may over-estimate stroke incidence in some people with HF, particularly those with a poor prognosis. |
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| ジャーナル名 | The British journal of general practice : the journal of the Royal College of General Practitioners |
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| Pubmed追加日 | 2025/1/9 |
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| 投稿者 | Jones, Nicholas Robert; Smith, Margaret; Lay-Flurrie, Sarah; Yang, Yaling; Hobbs, Fd Richard; Taylor, Clare |
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| 組織名 | University of Oxford Department of Primary Care Health Sciences, Oxford, United;Kingdom nicholas.jones2@phc.ox.ac.uk.;University of Oxford, Nuffield Department of Primary Care Health Sciences,;Oxford, United Kingdom.;Kingdom.;University of Birmingham, Institute of Applied Health Research, Birmingham,;United Kingdom. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/39778943/ |
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