ArticleThe British journal of general practice : the journal of the Royal College of General Practitioners2025
Stroke incidence in heart failure and atrial fibrillation: a population-based retrospective cohort study.
Article in The British journal of general practice : the journal of the Royal College of General Practitioners, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- P2X7 receptors promote atrial remodeling and atrial fibrillation susceptibility via reactive oxygen species-mediated mitogen-activated protein kinase signaling activation.Journal of cell communication and signaling · 2026Article
- A Lumped-Parameter Cardiovascular Model for Investigating Hemodynamic Alterations During Atrial Fibrillation.Bioengineering (Basel, Switzerland) · 2026Article
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6 authors.
Funding
Abstract
backgroundHeart failure (HF) is a risk factor for stroke among people with atrial fibrillation (AF). Prognosis following an HF diagnosis is often poor, but this is not accounted for in existing stroke risk scores.
aimTo examine stroke incidence in people with HF and AF compared with AF alone, considering the competing risk of death. DESIGN AND
settingA population-based retrospective cohort study in English primary care, linked to secondary care Hospital Episode Statistics data.
methodIn total, 2 381 941 people aged ≥45 years were identified in the Clinical Practice Research Datalink from 2000 to 2018. HF and AF were included as time-varying covariates; 69 575 had HF and AF, 141 562 had AF alone, and 91 852 had HF alone. Hazard ratios (HRs) for first stroke are reported using the Cox model and the Fine-Gray model.
resultsOver median follow-up of 6.62 years, 93 665 people (3.9%) had a first stroke and 314 042 (13.2%) died. Over half (51.3%) of those with HF, with or without AF, died. In the fully adjusted Cox model, relative stroke risk was highest among people with AF alone (HR 2.43, 95% confidence interval [CI] = 2.38 to 2.48), followed by HF and AF (HR 2.20, 95% CI = 2.14 to 2.26). The cumulative incidence function of stroke was also highest among those with AF only once accounting for the competing risk of all-cause mortality. In a Fine-Gray model, the relative risk of stroke was similar for people with AF alone (HR 2.38, 95% CI = 2.33 to 2.43), but there was significant attenuation among those with HF and AF (HR 1.48, 95% CI = 1.44 to 1.53).
conclusionHF is an aetiological risk factor for stroke, yet its prognostic significance is reduced by the high incidence of death. Use of the CHA
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