TITLE:
Clinical Heart Failure Patients with Ischemic Stroke Have a High Incidence (>60%) of Atrial Fibrillation or Flutter Whether Systolic Function Is Preserved or Depressed
AUTHORS:
Jacob I. Haft, Louis E. Teichholz
KEYWORDS:
Congestive Heart Failure, Ischemic Stroke, Atrial Fibrillation
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.4 No.9,
August
25,
2014
ABSTRACT: Clinical congestive heart failure (CHF) is a major risk factor for
strokes. Patients with CHF commonly have atrial fibrillation or flutter (AF),
which is frequently associated with, may be a marker for, and may be the mechanism
of, ischemic strokes. To determine whether stroke patients with CHF have a high
incidence of AF (that may be intermittent and not diagnosed), we reviewed all
the 12 lead ECGs in a fourteen year institutional ECG data base and the
clinical records and the available echocardiograms of 985 patients who had an
ischemic stroke over a 3-year period. We found that 31.3% of the stroke
patients had evidence of AF. Clinical congestive heart failure was present in
168 stroke patients; 61.9% of these stroke patients with CHF had evidence of
AF. In the total stroke population, patients with other risk factors for stroke
(hypertension, advanced age, diabetes, coronary artery disease) had an
increased incidence of AF; but among stroke patients with CHF, only advanced
age (≥75 years) in addition to CHF increased the incidence of AF. To determine whether
only the CHF stroke pts with systolic dysfunction had a high incidence of AF, we
compared the incidence of AF in the 41.5% of the CHF patients with a depressed
ejection fraction with the AF incidence in the 58.5% of CHF stroke patients
with a normal ejection fraction (≥50%). The incidence of AF was the same (63.4%
vs. 60.2%, p = 0.741) whether the ejection fraction was depressed
or normal. These findings suggest that AF is common in patients with CHF who
have strokes whether the ejection fraction is normal or depressed. CHF patients
who have strokes and who are in sinus rhythm should be meticulously
investigated for intermittent AF, so anticoagulation can be administered to
prevent a further stroke.