Why the study?
Heart failure is a known stroke risk factor in atrial fibrillation, but existing stroke risk scores do not account for the poor prognosis following an HF diagnosis.
Does heart failure increase the risk of stroke in patients with atrial fibrillation when accounting for the competing risk of death?
Population
2 381 941 people aged ≥45 years in English primary care
Comparison
HF and AF vs AF alone vs HF alone
Design
Population-based retrospective cohort study
Follow-up
Median 6.62 years
Key result
After accounting for the competing risk of all-cause mortality, the relative risk of stroke was significantly attenuated among people with heart failure and atrial fibrillation (HR 1.48).
Authors
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HF attenuates stroke risk estimates in AF after competing mortality adjustment; leaves open whether CHA2DS2-VASc overestimates risk in this population.
Cohort (n=2,381,941)
Does heart failure increase the risk of stroke in patients with atrial fibrillation when accounting for the competing risk of death?
Effect estimate: HR 1.48 (95% CI 1.44-1.53)
Because of the high competing risk of death, heart failure may be a relatively poor predictor of stroke among the population with atrial fibrillation, suggesting the CHA2DS2-VASc score may overestimate stroke risk in this group.
Jones et al. (2025) conducted a cohort in Heart failure and atrial fibrillation (n=2,381,941). Heart failure and atrial fibrillation vs. Neither condition was evaluated on First stroke (Fine and Gray model accounting for all-cause mortality) (HR 1.48, 95% CI 1.44-1.53). After accounting for the competing risk of all-cause mortality, the relative risk of stroke was significantly attenuated among people with heart failure and atrial fibrillation (HR 1.48).
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