Impact of Heart Failure Treatment and Empagliflozin on Stroke Risk in People with Atrial Fibrillation and Heart Failure: A Secondary Analysis from the EMPEROR-Preserved Study

Atrial fibrillation (AF) is a condition that causes an irregular heartbeat, significantly increasing the risk of stroke. Around 2.7 million people in the U.S. have AF, making it a major cause of stroke. Another condition, congestive heart failure (HF), also increases the risk of stroke. In heart failure, the heart can't pump blood effectively, leading to complications like fluid buildup. When AF and heart failure happen together, the risk of stroke becomes even higher. Doctors use a tool called the CHA2DS2-VASc score (which stands for congestive heart failure, hypertension, age, diabetes mellitus, prior stroke or TIA or thromboembolism, vascular disease, age, sex category) to assess stroke risk in AF patients based on factors like age, gender, and heart failure.

There are different types of heart failure, and heart failure with preserved ejection fraction (HFpEF) is the most common. In HFpEF, the heart muscle contracts normally, but it has difficulty relaxing and filling with blood. Research has shown that people with both HFpEF and AF are at the highest risk for stroke, but there is still a lot we don’t know about the link between these two conditions and stroke.

Most studies that look at heart failure and stroke risk only check heart failure at one point in time, like measuring heart function or certain blood markers. However, heart failure is a long-term condition that can change over time, and it’s important to understand how these changes impact stroke risk. NT-proBNP, a protein in the blood, can show how the heart is doing, but little is known about how changes in heart failure or NT-proBNP levels affect stroke risk in AF patients with HFpEF.

Our study will focus on a secondary analysis of data only from the EMPEROR-Preserved clinical trial (without new patient recruitment), to investigate how heart failure treatments and empagliflozin may affect stroke risk in people with both atrial fibrillation and heart failure. By studying this, doctors may be able to better identify patients at high risk of stroke and adjust their treatments to help prevent it.

The medication empagliflozin has been shown to help reduce heart problems in HFpEF patients. It works by helping the kidneys remove excess sugar and salt from the body, lowering blood pressure and reducing the strain on the heart. Though it has been shown to improve heart health, its impact on stroke risk in AF patients with HFpEF hasn’t been well-studied. This research will also explore whether empagliflozin can help reduce stroke risk in this group of patients.