Age Dependence of Risk Factors for Stroke and Death in Young Patients With Atrial Fibrillation

Abstract

8 the CHADS 2 score has been refined by use of the CHA 2 DS 2 -VASc (congestive heart failure, hypertension, age ≥75 years [doubled], diabetes, stroke/transient cerebral ischemia/thromboembolism [doubled], vascular disease [previous myocardial infarction, peripheral artery disease, or aortic plaque], age 65-74 years, sex category [female]) score. 9 The CHA 2 DS 2 -VASc score includes additional common stroke risk factors. [10][11][12] The CHA 2 DS 2 -VASc score better identifies the truly low-risk patients with AF who do not require any antithrombotic therapy, so that those with ≥1 stroke risk factors can be offered effective antithrombotic treatment. 9Risk stratification scores for AF have primarily been evaluated in patients with AF with a mean age >65 years. No study has adequately investigated whether risk factors of the CHA 2 DS 2 -VASc score have similar impact among younger patients with AF, and secondly, whether the increasing number of CHA 2 DS 2 -VASc risk factors is associated with comparable increases in stroke risk in all age groups. We hypothesize that the CHA 2 DS 2 -VASc Background and Purpose-The risk of stroke and death in patients with atrial fibrillation is strongly associated with age and concomitant comorbidities. The aim of this study was to examine the age dependence of risk factors for stroke and mortality in young patients with atrial fibrillation. Methods-This study is a population-based cohort study of 30-to 65-year-old patients with atrial fibrillation and diagnosed during 2000 to 2011, identified by record linkage between nationwide Danish registries. Cox regression models were used to estimate the risk of stroke and mortality according to risk factors within age groups: 30 to 50, 50 to 65, and 65 to 75 years. Results-We identified 73 799 nonvalvular atrial fibrillation patients, of which 37 782 (51.2%) were <65 years old (mean age 62.8). A higher modified cardiac failure or dysfunction, hypertension, age 75 (doubled), diabetes, stroke (doubled), vascular disease, age 65-74 and sex category (female) score (CHA 2 DS 2 -VASc score) was associated with decreased survival probability in all age groups. The overall incidence of stroke per year for 1 year (5 years) follow-up was 1.2% (0.6%), 3.5% (1.6%), and 5.6% (2.8%), respectively, for the age groups of 30 to 50, 50 to 65, and 65 to 75. Overall, risk factors such as previous stroke, heart failure, vascular disease, diabetes mellitus, and hypertension remained independent predictors of stroke and death in patients <65 years old with nonvalvular atrial fibrillation. Conclusions-The CHA 2 DS 2 -VASc score is an applicable tool for all age groups and in nonvalvular atrial fibrillation patients <65 years old, the same risk factors apply. (Stroke. 2014;45:1331-1337.)

Long-Term Mortality After First-Ever and Recurrent Stroke in Young Adults

“…30 Dissection is typically related to good prognosis, 32 a scenario complemented by the long-term follow-up of our young patients with stroke. The risk for death among young patients with atrial fibrillation has been considered low, 33 but our study shows that the risk for death is much higher among stroke patients with atrial fibrillation than among the normal population matched with age, sex, and geographical area. Our estimates of the observed and expected mortality among smaller Trial of Org 10172 in Acute Stroke Treatment subgroups may be instable, but our findings suggest that in all pathogenetic subgroups except low-risk source of cardioembolism and internal carotid artery dissection groups, the observed mortality exceeds the expected mortality in the general population.…”

Increased Risk of First-Ever Stroke in Younger Patients With Atrial Fibrillation Not Recommended for Antithrombotic Therapy by Current Guidelines: A Population-Based Study in an East Asian Cohort of 22 Million People

“…The stroke-free survival rate was also compared between elderly patients with AF and those without AF (aged !65 years) who had none of the CHA 2 DS 2 -VASc comorbidities throughout the observation period. The magnitude of a lower stroke-free survival rate in younger patients with AF is less than that in elderly patients with AF, which is in line with the observation by Melgaard et al, 31 indicating that age is a powerful driver of stroke risk in patients with AF. Collectively, our data revealed that younger patients with AF (aged 30-55 years) who had none of the conventional CHA 2 DS 2 -VASc risk factors and were not recommended for the prevention of thromboembolic stroke 24,25 may actually have higher absolute risk of stroke than did their non-AF counterparts during long-term follow-up in this patient subset.…”

Relationship of Age With Stroke and Death in Anticoagulated Patients With Nonvalvular Atrial Fibrillation

“…Data on the elderly from the Danish nationwide cohort study clearly show how age ≥75 years represents a particularly high-risk patient group for recurrent stroke/thromboembolism. 21 Of note, previous CAD, aspirin use, and poor TTR control also emerged as independent predictors for any clinically relevant bleeding among anticoagulated patients with AF.…”