Heart failure more strongly associated with stroke in young vs older patients with AF

Heart failure (HF) shows an age-dependent association with ischaemic stroke in patients with atrial fibrillation (AF), such that the association is more pronounced in young than older patients, as shown in the Finnish Anticoagulation in Atrial Fibrillation study.

The study included 229,565 patients (mean age 72.7 years, 50 percent female) with new‐onset AF in Finland. Of these, 13,377 were in the <50-year age group, 22.768 were in the 50–59-year age group, 50,458 were in the 60–69-year age group, 67,389 were in the 70–79-year age group, 61,241 were in the 80–89-year age group, and 14,332 were in the ≥90-year age group.

Patients in the older age group had a greater burden of comorbidities and a higher mean CHA₂DS₂‐VA score compared with younger patients. HF prevalence increased progressively with age, reaching 4.3 percent, 8.8 percent, 11 percent, 15.2 percent, 26.1 percent, and 38.7 percent in the <50, 50–59, 60–69, 70–79, 80–89, and ≥90 years age groups, respectively.

Over a median follow-up of 3.24 years, the incidence of ischaemic stroke associated with HF was highest among younger patients (incidence rate ratio of ≥2 in the <60-year age group) and gradually diminished with advancing age, approaching an incidence rate ratio of ≈1.0 in the oldest group (p<0.001 for interaction between age and incidence rate ratio).

The adjusted absolute rate difference between patients with and without HF remained stable, at ≈1 event per 100 patient‐years, across all age categories.

The findings highlight the importance of considering HF in the decision making about oral anticoagulation, particularly in younger patients.