Abstract 4339614: Ischemic Stroke in Atrial Fibrillation and Hypertrophic Cardiomyopathy: Insights From a Large Propensity Score Matched Analysis

Background: Incidence of ischemic stroke (CVA) in patients with atrial fibrillation (AF) and hypertrophic cardiomyopathy (HCM) is not well known. Objective: To evaluate the risk of CVA in pts with AF and HCM versus AF and no HCM from a large TriNetX database using propensity score matched (PSM) cohorts to account for confounding by other comorbidities. Methods: In this retrospective cohort analysis, we utilized International Classification of Diseases (ICD 10) codes querying the TriNetX federated health research network database that included 69 healthcare organizations. Two cohorts were defined: patients with AF and HCM (Cohort 1, n=34,169) and patients with AF but no HCM (Cohort 2, n=1,863,521). PSM was used to balance baseline characteristics, resulting in two matched cohorts of 33,867 patients in each. Kaplan-Meier survival analysis and hazard ratios were utilized to compare the risk of CVA. The mean follow-up time was approximately 992 days (~2.7 years) for the AF HCM cohort and 965 days (~2.6 years) for the AF no HCM cohort. Results: Baseline demographic and clinical characteristics between cohorts were balanced using PSM. The incidence of CVA was higher in the AF HCM group (12%, 4,054 patients) compared to the AF no HCM group(10.4%, 3,534 patients). Hazard ratio was 1.113 (95% CI: 1.064–1.165, p<0.001), indicating a 11.3% higher CVA risk in AF HCM patients. Survival probabilities at the end of follow-up were 66.14% in the AF HCM cohort and 70.46% in the AF no HCM cohort. Conclusion: AF patients with HCM have a significantly increased risk of CVA compared to those without HCM, even after adjusting for demographic and clinical factors. These findings emphasize the need for targeted stroke prevention strategies in this high-risk population and suggest that HCM should be a critical consideration in future stroke risk stratification models.