SYSTEMIC THROMBOEMBOLISM IN CHRONIC HEART-FAILURE - A PROSPECTIVE-STUDY IN 406 PATIENTS

In patients with heart failure the risk of systemic thromboembolism an d the benefit of anticoagulation are uncertain. To assess the incidenc e of systemic thromboembolism and the factors associated with an incre ased risk, 406 consecutive patients with chronic heart failure were pr ospectively investigated. Their left ventricular ejection fraction was 23 +/- 8%, pulmonary wedge pressure 19 +/- 10 mmHg and cardiac index 2.3 +/- 1.41 . min(-1). m(-2) of body surface area. Two hundred patien ts were in NYHA functional class III-IV. Two hundred and thirty-two pa tients were receiving oral anticoagulants. Over a follow-up period of 16+/-11 months, thromboembolism occurred in 11 patients (2.7%), seven of whom were on anticoagulants. Among clinical, echocardiographic and haemodynamic variables, atrial fibrillation, more severe haemodynamic impairment and low exercise capacity were associated with increased th romboembolic risk. No echocardiographic findings, including the presen ce of intracavitary thrombi, either at baseline or during follow-up, w ere related to subsequent thromboembolic events. The rate of embolism did not differ in patients receiving anticoagulants (4%) compared with those who did not receive anticoagulants (1%). No major bleeding occu rred during follow-up. Thus, in patients with chronic heart failure an d sinus rhythm the incidence of systemic thromboembolism is low regard less of anticoagulant treatment. Atrial fibrillation, particularly whe n associated with low cardiac index, identifies a subgroup of patients at high risk of events. In this subgroup, a moderate-intensity antico agulant regimen provides unsatisfactory protection against thromboembo lism.