Low Body Weight Is Associated With the Incidence of Stroke in Atrial Fibrillation Patients　– Insight From the Fushimi AF Registry –

Hamatani, Yasuhiro; Ogawa, Hisashi; Uozumi, Ryuji; Iguchi, Moritake; Yamashita, Yugo; Esato, Masahiro; Yuan, Chun; Tsuji, Hikari; Wada, Hiromichi; Hasegawa, Koji; Abe, Mitsuru; Morita, Satoshi; Akao, Masaharu

doi:10.1253/circj.cj-14-1245

Cited by 64 publications

(64 citation statements)

References 35 publications

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“…The Fushimi AF registry reported that AF patients with low body weight had a higher risk for stroke/ SEE and all-cause death, whereas no influence was evident for major bleeding. 33 The mortality risk associated with being overweight has been confirmed in the general population.…”

Section: Discussionmentioning

confidence: 95%

Is There an Obesity Paradox for Outcomes in Atrial Fibrillation?

Proietti

Guiducci

Cheli

et al. 2017

Stroke

110

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Background and Purpose-Obesity is a risk factor for all-cause and cardiovascular death but, despite this, an inverse relationship between overweight or obesity and a better cardiovascular prognosis in long-term follow-up studies has been observed; this phenomenon, described as obesity paradox, has also been found evident in atrial fibrillation cohorts. Methods-We performed a systematic review on the relationship between body mass index and major adverse outcomes in atrial fibrillation patients. Moreover, we provided a meta-analysis of non-vitamin K antagonist oral anticoagulants (NOACs) trials. Results-An obesity paradox was found for cardiovascular death and all-cause death in the subgroup analyses of randomized trial cohorts; however, observational studies fail to show this relationship. From the meta-analysis of NOAC trials, a significant obesity paradox was found, with both overweight and obese patients reporting a lower risk for stroke/systemic embolic event (odds ratio

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Section: Discussionmentioning

confidence: 95%

Is There an Obesity Paradox for Outcomes in Atrial Fibrillation?

Proietti

Guiducci

Cheli

et al. 2017

Stroke

110

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“…With regard to the latter, we have recently demonstrated that low body weight (≤50 kg) was independently associated with the incidence of stroke/SE in Japanese patients with AF. 21 We further A B …”

Section: Discussionmentioning

confidence: 99%

Incidence of Stroke or Systemic Embolism in Paroxysmal Versus Sustained Atrial Fibrillation

Takabayashi

Hamatani

Yamashita

et al. 2015

Stroke

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106

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A trial fibrillation (AF) is the most common cardiac arrhythmia in developed countries and increases the risks for stroke, heart failure, and death.1 Until 2 decades ago, the incidence and risk factors for stroke were less well characterized in patients with paroxysmal AF (PAF) when compared with those with persistent or permanent AF.2,3 Since then, several studies have reported that patients with PAF have a risk of thromboembolic events that was similar to that in persistent or permanent AF. [4][5][6][7] In accordance with the results from these studies, current guidelines worldwide recommend the use of oral anticoagulant (OAC) for the prevention of thromboembolism, irrespective of the type of AF. [8][9][10] However, more recent studies have reported that the patients with PAF had a lower rate of stroke/systemic embolism (SE). 11-13Also, patients with PAF are less likely to receive OAC therapy in the real-world clinical practice.6,14 However, limited data on stroke risk associated with PAF are evident in Asian populations with PAF because most studies were epidemiological studies on Western populations or selected clinical trial cohorts.Background and Purpose-There is controversy on the relationship of the type of atrial fibrillation (AF) to stroke.Although several studies show that patients with paroxysmal AF (PAF) have a stroke risk similar to those with persistent or permanent AF, recent studies suggest that PAF is associated with a lower rate of stroke. Limited data on stroke risk associated with PAF are evident in Asian populations. Methods-The Registry Study of Atrial Fibrillation Patients in Fushimi-ku (Fushimi AF Registry) is a community-basedsurvey of patients with AF in Fushimi-ku, Kyoto, Japan. Patients were categorized into 2 types of AF: PAF or sustained (persistent or permanent) AF. We compared clinical events between PAF (n=1588) and sustained AF (n=1716). Results-Patients with PAF were younger, had less comorbidities, and received oral anticoagulants (OAC) less commonly.A lower risk of stroke/systemic embolism during follow-up period in the patients with PAF was consistently observed (non-OAC users: hazard ratio, 0.45; 95% confidence intervals, 0.27-0.75; P<0.01 and OAC users: hazard ratio, 0.59; 95% confidence interval, 0.35-0.93; P=0.03). The composite end point of stroke/systemic embolism/all-cause mortality was also lower in PAF, whether among OAC users (hazard ratio, 0.77; 95% confidence interval, 0.59-0.99; P=0.046) or non-OAC users (hazard ratio, 0.59; 95% confidence interval, 0.46-0.75; P<0.01). On multivariate analysis, PAF was an independent predictor of lower stroke/systemic embolism risk. Conclusions-In this large cohort of Japanese patients with AF, PAF was independently associated with lower incidence of stroke/systemic embolism than sustained AF. This may aid decision making for anticoagulation, especially in those patients with AF with few stroke risk factors. Clinical Trial Registration

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“…In a previous cohort study of Japanese patients with AF, the incidence rate of adverse events (death or stroke/SE) was 8.7 per 100 person-years 17. In addition, when the previous study focused on patients weighing less than 50 kg, the incidence rate of adverse events increased to 16.1 per 100 person-years 17.…”

Section: Discussionmentioning

confidence: 93%

The influence of frailty under direct oral anticoagulant use in patients with atrial fibrillation

et al. 2019

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BackgroundFrailty is a prognostic factor in patients with atrial fibrillation (AF). However, there is no report on the associations between frailty and clinical adverse events in patients with AF taking direct oral anticoagulants (DOAC). The factors related to the occurrence of clinical adverse events are still under discussion. Therefore, we examined the associations between frailty and clinical adverse events in patients with AF taking DOAC in daily clinical practice.MethodsWe retrospectively evaluated 240 consecutive patients with AF who had been newly prescribed DOAC in our hospital from April 2016 through May 2017. Data collected included Clinical Frailty Scale (CFS) scores, laboratory results and basic demographic information.ResultsDuring the mean follow-up period of 13.4 months, 20 patients died (7.6 per 100 person-years), stroke or systemic embolism occurred in seven patients (2.6 per 100 person-years) and major bleeding occurred in 11 patients (4.2 per 100 person-years). We defined these adverse events as composite end points, and we estimated adjusted HRs and 95% CIs for risk factors using the Cox proportional hazard regression model. Frailty (defined as a CFS score of 5 or more; HR: 3.71; 95% CI: 1.59 to 8.65), female sex (HR: 3.49; 95% CI: 1.73 to 7.07), serum albumin level (HR: 0.47; 95% CI: 0.28 to 0.79) and malignancy (HR: 4.02; 95% CI: 1.83 to 8.84) were independent predictors of the composite end points.ConclusionsFrailty, female sex, hypoalbuminaemia and malignancy were associated with clinical adverse events in patients with AF who were prescribed DOAC.

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Low Body Weight Is Associated With the Incidence of Stroke in Atrial Fibrillation Patients　– Insight From the Fushimi AF Registry –

Cited by 64 publications

References 35 publications

Is There an Obesity Paradox for Outcomes in Atrial Fibrillation?

Is There an Obesity Paradox for Outcomes in Atrial Fibrillation?

Incidence of Stroke or Systemic Embolism in Paroxysmal Versus Sustained Atrial Fibrillation

The influence of frailty under direct oral anticoagulant use in patients with atrial fibrillation

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Low Body Weight Is Associated With the Incidence of Stroke in Atrial Fibrillation Patients – Insight From the Fushimi AF Registry –

Cited by 64 publications

References 35 publications

Is There an Obesity Paradox for Outcomes in Atrial Fibrillation?

Is There an Obesity Paradox for Outcomes in Atrial Fibrillation?

Incidence of Stroke or Systemic Embolism in Paroxysmal Versus Sustained Atrial Fibrillation

The influence of frailty under direct oral anticoagulant use in patients with atrial fibrillation

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Product

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Low Body Weight Is Associated With the Incidence of Stroke in Atrial Fibrillation Patients　– Insight From the Fushimi AF Registry –