Atrial Fibrillation and Stroke in Elderly Patients

Dang, Geetanjali; Jahangir, Imaan A; Sra, Jasbír; Tajik, A. Jamil; Jahangir, Arshad

doi:10.17294/2330-0698.1409

Cited by 5 publications

(4 citation statements)

References 88 publications

(100 reference statements)

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“…20 Specifically, while NVAF is associated with a 5-fold increase in the risk of ischemic stroke, this risk is 17-fold in patients with mitral stenosis. 6 In our review, the overall risk of AIS in patients with any type of VAF on DOAC was 3.5% (1511/42877), which is comparable to the risk in patients with NVAF on DOAC (3%) or on warfarin (3.7%) and in patients with VAF on warfarin (1.4-7%). 19 Although, in our review, AIS seemed to occur more often in patients with mitral valvular disease (5.3%), AIS did not occur at all (0%) in a cohort of VAF patients with severe valvular disease.…”

Section: Discussionmentioning

confidence: 53%

“…atrial fibrillation in patients with prosthetic valves or aortic/mitral valve dysfunction), although the risk of AIS in these patients are up to 17-fold higher than the general population. 6 This scoping review aims (1) to examine and map the clinical cerebrovascular outcomes and (2) to identify knowledge gaps in patients with valvular AF treated with DOACs.…”

Section: Introductionmentioning

confidence: 99%

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Current Stroke Clinical Outcomes of Direct Anticoagulation Therapy in Patients with Valvular Atrial Fibrillation: A Scoping Review

Dabhi

Chu

Roach

et al. 2023

Preprint

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Background: While direct oral anticoagulants (DOACs) have been proven effective in stroke prevention in patients with non-valvular AF (NVAF), there is limited evidence-based guidance on DOAC use in valvular atrial fibrillation. This scoping review aims to examine clinical cerebrovascular outcomes and safety profiles within valvular AF (VAF) patients treated with DOACs. <break>Methods: This scoping review was conducted following the Joanna Briggs Institute methodology for scoping reviews and reported consulting the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews checklist. Pubmed, OVID Medline and Web of Science databases were searched for manuscripts published from inception to July 25, 2022 and included based on pre-registered criteria. Data extraction included patient demographics, valvular disease and Afib classification, DOAC type , cerebro-cardiovascular outcomes variables, and bleeding risks. <break>Results: There were 12 studies with 69,741 VAF patients treated with DOACs. At the 12-month follow-up, acute ischemic stroke and major bleeding events occurred in 3.5% and 5.8% of these patients, respectively. <break>Conclusion: DOACs in VAF were associated with similar clinical cerebrovascular outcomes with decreased risk of fatal bleeding rates when compared to warfarin. More controlled studies are needed to further assess the safety and efficacy of DOACs in this population.

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Section: Discussionmentioning

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Current Stroke Clinical Outcomes of Direct Anticoagulation Therapy in Patients with Valvular Atrial Fibrillation: A Scoping Review

Dabhi

Chu

Roach

et al. 2023

Preprint

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“…21 Overall, the report's large sample of patients hospitalized for acute mesenteric ischemia helps fill in existing knowledge gaps regarding atrial fibrillation, since the relatively low incidence of this complication has yielded limited published information. 22 In a timely review article, Dang et al 23 provide an update on stroke in atrial fibrillation, an important public health issue contributing to disability and death in elderly patients. 1 The authors review pathogenesis of thromboembolism in atrial fibrillation, define predisposing clinical characteristics and risk factors for stroke and summarize select issues in its management, including the use of novel anticoagulants and nonpharmacological approaches to reducing stroke risk in older-age patients with atrial fibrillation.…”

Section: This Issue Of the Journal Of Patient-centeredmentioning

confidence: 99%

Seniors Welcome! Avoiding the Trap of Age Limits in Health Research

Jahangir¹

2016

Journal of Patient-Centered Research and Reviews

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“… 2 , 3 , 4 , 5 Moreover, its has been shown that individuals aged 80 years or older have >20% of atrial fibrillation–related strokes 5 and these are often more severe in terms of disability and mortality. 5 , 6 , 7 While oral anticoagulation therapy is the mainstay for thromboembolic cerebrovascular accidents prevention, 6 , 8 elderly patients are at increased risk of bleeding events 3 , 9 ; hence, these drugs are often underused, mainly because of advanced age or the perceived high‐risk of bleeding complications, falls, or even polypharmacy. 3 , 6 , 7 , 10 …”

mentioning

confidence: 99%

Outcomes of Elderly Patients Undergoing Left Atrial Appendage Closure

Sanjoy

Choi

Sparrow

et al. 2021

JAHA

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Background Elderly patients have a higher burden of comorbidities that influence clinical outcomes. We aimed to compare in‐hospital outcomes in patients ≥80 years old to younger patients, and to determine the factors associated with increased risk of major adverse events (MAE) after left atrial appendage closure. Methods and Results The National Inpatient Sample was used to identify discharges after left atrial appendage closure between October 2015 and December 2018. The primary outcome was in‐hospital MAE defined as the composite of postprocedural bleeding, vascular and cardiac complications, acute kidney injury, stroke, and death. A total of 6779 hospitalizations were identified, of which, 2371 (35%) were ≥80 years old and 4408 (65%) were <80 years old. Patients ≥80 years old experienced a higher rate of MAE compared with those aged <80 years old (6.0% versus 4.6%, P =0.01), and this difference was driven by a numerically higher rate of cardiac complications (2.4% versus 1.8%, P =0.09) and death (0.3% versus 0.1%, P =0.05) among individuals ≥80 years old. In patients ≥80 years old, higher odds of in‐hospital MAE were observed in women (1.61‐fold), and those with preprocedural congestive heart failure (≈2‐fold), diabetes (≈1.5‐fold), renal disease (≈2.6‐fold), anemia (≈2.7‐fold), and dementia (≈5‐fold). In patients <80 years old, a higher risk of in‐hospital MAE was encountered among women (≈1.4‐fold) and those with diabetes (≈1.3‐fold), renal disease (≈2.6‐fold), anemia (≈2‐fold), and dyslipidemia (≈1.2‐fold). Conclusions Patients ≥80 years old had higher rates of in‐hospital MAE compared with patients aged <80 years old. Female sex and the presence of heart failure, diabetes, renal disease, and anemia were factors associated with in‐hospital MAE among both groups.

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Atrial Fibrillation and Stroke in Elderly Patients

Cited by 5 publications

References 88 publications

Current Stroke Clinical Outcomes of Direct Anticoagulation Therapy in Patients with Valvular Atrial Fibrillation: A Scoping Review

Current Stroke Clinical Outcomes of Direct Anticoagulation Therapy in Patients with Valvular Atrial Fibrillation: A Scoping Review

Seniors Welcome! Avoiding the Trap of Age Limits in Health Research

Outcomes of Elderly Patients Undergoing Left Atrial Appendage Closure

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