Increasing atrial fibrillation prevalence in acute ischemic stroke and TIA

Abstract

Objective: To evaluate trends in atrial fibrillation (AF) prevalence in acute ischemic stroke (AIS) and TIA in the United States.Methods: We used the Nationwide Inpatient Sample to retrospectively compute weighted prevalence of AF in AIS (n 5 4,355,140) and TIA (n 5 1,816,459) patients admitted to US hospitals from 2004 to 2013. Multivariate-adjusted models were used to evaluate the association of AF with clinical factors, mortality, length of stay, and cost.Results: From 2004 to 2013, AF prevalence increased by 22% in AIS (20%-24%) and by 38% in TIA (12%-17%). AF prevalence varied by age (AIS: 6% in 50-59 vs 37% in $80 years; TIA: 4% in 50-59 vs 24% in $80 years), sex (AIS: male 19% vs female 25%; TIA: male 15% vs female 14%), race (AIS: white 26% vs black 12%), and region (AIS: Northeast 25% vs South 20%). Advancing age, female sex, white race, high income, and large hospital size were associated with increased odds of AF in AIS. AF in AIS was a risk factor for in-hospital death (odds ratio 1.93, 95% confidence interval 1.89-1.98) but mortality in AIS with AF decreased from 11.6% to 8.3% (p , 0.001). Compared to no AF, AF was associated with increased cost of $2,310 and length of stay 1.1 days in AIS.Conclusions: AF prevalence in AIS and TIA has continued to increase. Disparity in AF prevalence in AIS and TIA exists by patient and hospital factors. AF is associated with increased mortality in AIS. Innovative AIS preventive strategies are needed in patients with AF, especially in the elderly. Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia 1 and is associated with a 5-fold increased risk of acute ischemic stroke (AIS).2 Between 2.7 and 6.1 million people in the United States have AF and as the US population ages, this number is projected to more than double by 2050.3 Accurate understanding of variations in AF prevalence in AIS is important for discerning changes in the epidemiologic, clinical, and social characteristics of AIS over time, but contemporary large-scale data on the burden of AF-associated AIS in the United States are lacking. While AF-related hospitalizations in the United States increased over the last decade, 4 it remains unclear what direction and by how much AF-associated AIS changed over this period.The primary aim of our study is to quantify and describe trends in the prevalence of AF in hospitalized AIS and TIA patients in the United States from 2004 to 2013. We secondarily evaluated the association of AF with other socioeconomic and hospital-level factors in AIS and evaluated the current association of comorbid AF with in-hospital mortality, length of stay (LOS), and hospitalization cost in AIS. all-payer inpatient care database in the United States and comprises a 20% stratified random sample of all US hospital discharges. Each discharge in the NIS is de-identified so all discharges were considered to be independent. The unit for this analysis was each discharge rather than each individual. Further details on the NIS design are available at hcup-us.ahrq....

Atrial fibrillation in hospitalized patients with end‐stage liver disease: temporal trends in prevalence and outcomes

“…This quantitative difference might lie in a higher severity of liver disease in our study, namely ESLD or decompensated cirrhosis. It has been previously well established that age, sex, race, income and insurance differences exist in AF prevalence in the general population or specific conditions like acute ischaemic stroke and end‐stage chronic obstructive pulmonary disease . Consistent with other studies, we found that advancing age, male, white race, higher income and Medicare insurance were related to increased AF occurrence.…”

“…It has been previously well established that age, sex, race, income and insurance differences exist in AF prevalence in the general population or specific conditions like acute ischaemic stroke and end-stage chronic obstructive pulmonary disease. [33][34][35] Consistent with other studies, 17,19 we found that advancing age, male, white race, higher income and Medicare insurance were related to increased AF occurrence. More studies regarding these disparities are needed to provide further explanation.…”

Free thyroxine within the normal reference range predicts risk of atrial fibrillation

“…AF currently affects over 5 million Americans, and this prevalence continues to increase . AF preferentially affects older adults (>70 years of age) and is a major risk factor for cardioembolic stroke . AF increases stroke‐risk 5‐fold, and 20% of all ischemic strokes present with AF .…”

“…AF preferentially affects older adults (>70 years of age) and is a major risk factor for cardioembolic stroke . AF increases stroke‐risk 5‐fold, and 20% of all ischemic strokes present with AF . For adults reaching age 40, the risk of developing AF during their lifetime is approximately 1 in 4 .…”

Stroke Severity and Outcomes in Patients with and without Atrial Fibrillation

“…The increasing incidence and prevalence of stroke and AF itself is related to the aging of population [6]. It is entrenched that the incidences of AF among patients with IS are surging rapidly and thus results in higher general fatality as well as particularly higher stroke mortality rates [7,8]. Additionally, AF boosts health care and hospitalization expenditures, the usage of medical resources as well as the general economic burden which in itself is considerably weightful for stroke patients [9,10].…”