{"id":"fb5a3f7b53ac","type":"article","url":"https://hartvaat.nl/2017/03/07/cva-risico-bij-chronisch-hartfalen-met-behouden-ef-zonder-af-charm-analyse/","title":"CVA-risico bij chronisch hartfalen met behouden EF zonder AF: CHARM-analyse","title_en":"Risk of stroke in chronic heart failure patients with preserved ejection fraction, but without atrial fibrillation: analysis of the CHARM-Preserved and I-Preserve trials.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["step-hfpef"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw509","source_url":"https://doi.org/10.1093/eurheartj/ehw509","authors":["Azmil H Abdul-Rahim","Ana-Cristina Perez","Rachael L MacIsaac","Pardeep S Jhund","Brian L Claggett","Peter E Carson","Michel Komajda","Robert S McKelvie","Michael R Zile","Karl Swedberg","Salim Yusuf","Marc A Pfeffer","Scott D Solomon","Gregory Y H Lip","Kennedy R Lees","John J V McMurray"],"significance":7,"published":"2017-03-07","source_date":"2017-03-07","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/"],"congress":"","summary_en":"This CHARM analysis examined stroke risk in HFpEF patients without atrial fibrillation, finding a non-negligible stroke rate that raised questions about the potential role of anticoagulation even in AF-free heart failure patients.","created":"2026-07-03T10:26:35Z","updated":"2026-07-03T18:38:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de CHARM-trial naar het CVA-risico bij HFpEF-patiënten zonder atriumfibrilleren. Relevant voor de vraag of antistolling geïndiceerd is bij HFpEF zonder AF.","abstract_original":"AIMS: The incidence and predictors of stroke in patients with heart failure and preserved ejection fraction (HF-PEF), but without atrial fibrillation (AF), are unknown. We described the incidence of stroke in HF-PEF patients with and without AF and predictors of stroke in those without AF. METHODS AND RESULTS: We pooled data from the CHARM-Preserved and I-Preserve trials. Using Cox regression, we derived a model for stroke in patients without AF in this cohort and compared its performance with a published model in heart failure patients with reduced ejection fraction (HF-REF)-predictive variables: age, body mass index, New York Heart Association class, history of stroke, and insulin-treated diabetes. The two stroke models were compared and Kaplan-Meier curves for stroke estimated. The risk model was validated in a third HF-PEF trial. Of the 6701 patients, 4676 did not have AF. Stroke occurred in 124 (6.1%) with AF and in 171 (3.7%) without AF (rates 1.80 and 1.00 per 100 patient-years, respectively). There was no difference in performance of the stroke model derived in the HF-PEF cohort and the published HF-REF model (c-index 0.71, 95% confidence interval 0.57-0.84 vs. 0.73, 0.59-0.85, respectively) as the predictive variables overlapped. The model performed well in the validation cohort (0.86, 0.62-0.99). The rate of stroke in patients in the upper third of risk approximated to that in patients with AF (1.60 and 1.80 per 100 patient-years, respectively). CONCLUSIONS: A small number of clinical variables identify a subset of patients with HF-PEF, but without AF, at elevated risk of stroke."}