# CVA-risico bij chronisch hartfalen met behouden EF zonder AF: CHARM-analyse

*geplaatst 2017-03-07 · Hartfalen · European heart journal · doi 10.1093/eurheartj/ehw509 · https://hartvaat.nl/2017/03/07/cva-risico-bij-chronisch-hartfalen-met-behouden-ef-zonder-af-charm-analyse/*

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.

## English: 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.

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.

## Abstract (original, from the publication)

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.

Auteurs: 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

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Bron: European heart journal, https://doi.org/10.1093/eurheartj/ehw509. Bijgewerkt 2026-07-03T18:38:31Z. 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.