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Heart failure (HF) can be both a consequence of atrial fibrillation (AF) and a cause of the arrhythmia due to increased atrial pressure and volume overload, secondary valvular dysfunction, or chronic neurohumoral stimulation. In addition, hospitalizations are frequent in AF patients complicated with HF and may contribute to reduced quality of life. Our study was to investigate the risks of the thromboembolism events according to the differentiation of New York Heart Association (NYHA) function classes.
This study enrolled 5140 consecutive patients with NVAF who presented to our department of cardiology from November 2013 to October 2016. The following information was collected from the database: age, gender, history of hypertension, diabetes mellitus (DM), coronary artery disease (CAD), myocardial infarction (MI), HF, stroke or transient ischemic attack (TIA), thromboembolism, vascular disease, hyperlipidaemia, hyperuricemia, hyperthyroidism, hypothyroidism and obstructive sleep apnea (OSA). Multivariate logistic regression analyses were used to evaluate the association between HF and thromboembolism events in AF patients. We identified the optimal cut-off values of the New CHADS2 (NCHADS2) and New CHA2DS2-VASc (NCHA2DS2-VASc) scores each based on receiver operating characteristic (ROC) curves to predict the risk of thromboembolism events.
Of the 2221(43.2%) HF patients, 241 (4.7%) were NYHA I, 1980 (38.5%) were NYHA II–IV. In those 5140 AF patients, NYHA II–IV group (OR = 1.968, 95%CI 1.634-2.371, P<0.001) were associated with an increased odds ratio of the prevalence of thromboembolism events, after adjustment for age, gender, hypertension, DM, hyperlipemia, CAD, MI, hyperthyroidism, hypothyroidism, OSA, vascular disease. We classified NYHA I group as 0 point and NYHA II–IV group as 1 point in both CHADS2 and CHA2DS2-VASc scores. The differences between the CHADS2 area (AUC 0.827, 95%CI 0.806-0.849) and the NCHADS2 (AUC 0.831, 95%CI 0.810-0.852) area under the curves were not significant (P>0.05). In addition, the AUC for NCHA2DS2-VASc score predicting thromboembolism was 0.896 (0.885-0.907) with no significant difference (P>0.05), compared with CHA2DS2-VASc score (AUC 0.894, 95%CI 0.882-0.905).
Our data indicated that the risk of thromboembolism with NYHA classes II–IV was clear. But appropriate antithrombotic therapy in AF combined with NYHA I should be recommended, since the transmission of high risk rank to low risk rank for patients in NYHA I.