Lifetime Risks, Projected Numbers, and Adverse Outcomes in Asian Patients With Atrial Fibrillation

Chao, Tze Fan; Liu, Chia Jen; Tuan, Ta Chuan; Chen, Tzeng Ji; Hsieh, Ming Hsiung; Lip, Gregory Y. H.; Chen, Shih Ann

doi:10.1016/j.chest.2017.10.001

Cited by 136 publications

(143 citation statements)

References 38 publications

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“…In terms of manifestations of cardiovascular disease (CVD), Asians have a lower prevalence of atrial fibrillation (AF) than Caucasians (≈1% vs ≈1%‐2%) but the overall disease burden of AF in Asia is high because of the larger proportion of older individuals in the population . Based on data from a large study conducted in Taiwan, approximately one in seven individuals aged >20 years in Asia will develop AF in their lifetime; these rates are lower than those reported for Caucasians in the Framingham Heart Study and the Rotterdam study . Rates of heart failure also appear to be slightly lower in Asian vs Western populations but, as for AF, the number of patients in Asia who develop heart failure each year is high, indicating that the worldwide heart failure pandemic includes Asia .…”

Section: Asia‐specific Factorsmentioning

confidence: 99%

Diversity of and initiatives for hypertension management in Asia—Why we need the HOPE Asia Network

Kario

Chia

Sukonthasarn

et al. 2019

J of Clinical Hypertension

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The Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network was set up to improve the management of hypertension in Asia with the ultimate goal of achieving "zero" cardiovascular events. Asia is a diverse continent, and the prevalence of hypertension has increased over the last 30 years. There are a number of Asia-specific features of hypertension and hypertension-related cardiovascular complications, which means that a region-specific approach is needed. White-coat hypertension will become more of an issue over time as Asian populations age, and masked hypertension is more prevalent in Asian than in Western countries.Medical writing assistance was provided by Nicola Ryan, independent medical writer. Editorial assistance was provided by Ayako

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Section: Asia‐specific Factorsmentioning

confidence: 99%

Diversity of and initiatives for hypertension management in Asia—Why we need the HOPE Asia Network

Kario

Chia

Sukonthasarn

et al. 2019

J of Clinical Hypertension

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“…In nationwide administrative registers, whole populations can be followed over prolonged periods of time, with left censoring when the register started or immigration and right censoring at emigration or end of follow‐up. Often used registers with nationwide coverage have been available in Finland since 1969, in Denmark since 1978, in Sweden since 1987, and in Taiwan since 1996. Other large databases such as the CPRD in the UK have been operational about as long, but without full national coverage.…”

Section: Introductionmentioning

confidence: 99%

Short lookback periods causing exaggerated stroke risk estimates in atrial fibrillation may expose patients to unnecessary anticoagulant treatment

Friberg

2019

Pharmacoepidemiology and Drug

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Purpose The purpose was to investigate how different lookback periods in observational registry studies affect estimates of stroke risk in patients with atrial fibrillation and stroke risk score CHA2DS2‐VASc 1, a level where the appreciated risk is likely to affect decisions about oral anticoagulation. Methods All 354 854 individuals in Sweden with a hospital diagnosis of atrial fibrillation during 2010‐2016 were included. At least 13 years of observational data prior to inclusion was available for all patients. The prevalence of hypertension, heart failure, diabetes, previous thromboembolism, and vascular disease was estimated from data with different lookback periods. The incident stroke rates at CHA2DS2‐VASc score 1 was then assessed using data with successively longer lookback periods. Results Depending on duration of lookback period, the proportion of patients with heart failure varied 2.7 times, thromboembolism 3.7 times, hypertension 4.0 times, and diabetes and vascular disease both approximately 4.5 times. During follow‐up, 22 237 patients suffered an ischaemic stroke. The estimated risk without anticoagulant treatment at CHA2DS2‐VASc score 1 was 51% higher if the scores had been calculated with the shortest lookback period than if all information had been used. Conclusions Short lookback periods underestimate comorbidity, cause high‐risk patients to be misclassified as low risk, and overestimate stroke risk at CHA2DS2‐VASc 1. This may lead to unnecessary anticoagulant treatment of true low‐risk patients. Transparency regarding lookback periods is essential for interpretation and comparison of registry studies.

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Section: Introductionmentioning

confidence: 99%

“…The current prevalence of AF is about 1% in the general population, increases with age [2], and is estimated to reach 4.01% in 2050 [3]. In 2011, the lifetime risk of AF was reported to be about 1 in 7 for subjects aged >20 years [3]. In comparison to patients without AF, AF increases the risk of ischemic stroke (adjusted hazard ratio [aHR] = 3.34), heart failure (aHR = 3.31), mortality (aHR = 2.61), sudden cardiac death (aHR = 1.83), myocardial infarction (aHR = 1.62) and dementia (aHR = 1.56) [3].…”

Section: Introductionmentioning

confidence: 99%

“…In 2011, the lifetime risk of AF was reported to be about 1 in 7 for subjects aged >20 years [3]. In comparison to patients without AF, AF increases the risk of ischemic stroke (adjusted hazard ratio [aHR] = 3.34), heart failure (aHR = 3.31), mortality (aHR = 2.61), sudden cardiac death (aHR = 1.83), myocardial infarction (aHR = 1.62) and dementia (aHR = 1.56) [3]. Oral anticoagulants (OACs) reduce the risk of ischemic stroke in patients with AF who have an additional stroke risk factor.…”

Section: Introductionmentioning

confidence: 99%

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Oral anticoagulant use for stroke prevention in atrial fibrillation patients with difficult scenarios

Chang

Liao

Chao

et al. 2018

IJC Heart & Vasculature

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Atrial fibrillation (AF) has become the most prevalent arrhythmia and it will increase the risk of ischemic stroke, heart failure, mortality, sudden cardiac death, myocardial infarction, and dementia. Stroke prevention with oral anticoagulant is crucial for management of AF patients. Vitamin K antagonist, which inhibits the clotting factors II, VII, IX and X, has been recommended for stroke prevention for decades. Non-Vitamin K antagonist oral anticoagulants (NOACs), including dabigatran, rivaroxaban, apixaban and edoxaban are at least as effective as warfarin in reducing ischemic stroke with a lower rate of major bleeding. With the increasing prevalence of AF, prescription of the appropriate oral anticoagulants (OACs) according to patient's characteristics becomes a challenge. This review article aims to provide an overview of anticoagulant use in AF patients with difficult scenarios.

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Lifetime Risks, Projected Numbers, and Adverse Outcomes in Asian Patients With Atrial Fibrillation

Abstract: The burden of AF among Asian patients is increasing, with a lifetime risk of AF being 1 in 7. Optimized management of any associated comorbidities should be part of the holistic management approach for AF.

Cited by 136 publications

References 38 publications

Diversity of and initiatives for hypertension management in Asia—Why we need the HOPE Asia Network

Diversity of and initiatives for hypertension management in Asia—Why we need the HOPE Asia Network

Short lookback periods causing exaggerated stroke risk estimates in atrial fibrillation may expose patients to unnecessary anticoagulant treatment

Oral anticoagulant use for stroke prevention in atrial fibrillation patients with difficult scenarios

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