Mental health conditions and risk of <scp>first‐ever</scp> ischaemic stroke and death in patients with incident atrial fibrillation: A nationwide cohort study

Teppo, Konsta; Jaakkola, Jussi; Biancari, Fausto; Halminen, Olli; Putaala, Jukka; Mustonen, Pirjo; Haukka, Jari; Linna, Miika; Kinnunen, Janne; Tiili, Paula; Kouki, Elis; Penttilä, Tero; Hartikainen, Juha; A, Aro; Airaksinen, K. E. Juhani; Lehto, Mika

doi:10.1111/eci.13801

Cited by 9 publications

(4 citation statements)

References 36 publications

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“…The present substudy was conducted within a cohort of patients diagnosed with incident AF during 2007 to 2018, established in previous studies within the FinACAF cohort. 21 , 22 For this substudy, patients with any bleeding event, ischemic stroke, or aortic valve replacement before cohort entry were excluded to definitively distinguish the first‐ever outcome event. Follow‐up started from the date of the first recorded AF diagnosis, and the study observation period ended on December 31, 2018.…”

Section: Methodsmentioning

confidence: 99%

Aortic Stenosis and Outcomes in Patients With Atrial Fibrillation: A Nationwide Cohort Study

Teppo

Airaksinen

Biancari

et al. 2023

JAHA

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Background Patients with aortic stenosis (AS) have been underrepresented in the trials evaluating direct oral anticoagulants (DOACs) in atrial fibrillation (AF). We aimed to assess whether AS impacts outcomes in patients with AF and estimate the effects of DOACs versus warfarin in patients with AF and AS. Methods and Results The registry‐based FinACAF (Finnish Anticoagulation in Atrial Fibrillation) study covered all patients with AF diagnosed during 2007 to 2018 in Finland. Hazard ratios (HRs) of first‐ever gastrointestinal bleeding, intracranial bleeding, any bleeding, ischemic stroke, and death were estimated with cause‐specific hazards regression adjusted for anticoagulant exposure variables. We identified 183 946 patients (50.5% women; mean age, 71.7 [SD, 13.5] years) with incident AF without prior bleeding or ischemic stroke, of whom 5231 (2.8%) had AS. The crude incidence rate of all outcomes was higher in patients with AS than in patients without AS. After propensity score matching, AS was associated with the hazard of any bleeding, gastrointestinal bleeding, and death but not with intracranial bleeding or ischemic stroke (adjusted HRs, 1.36 [95% CI, 1.25–1.48], 1.63 [95% CI, 1.43–1.86], 1.32 [95% CI, 1.26–1.38], 0.96 [95% CI, 0.78–1.17], and 1.11 [95% CI, 0.99–1.25], respectively). Among patients with AS, DOACs were associated with a lower risk of ischemic stroke when compared with warfarin, while bleeding and mortality did not differ between DOACs and warfarin. Conclusions AS is associated with substantially higher risk of gastrointestinal bleeding in patients with AF. DOACs may be more effective in preventing ischemic stroke than warfarin in patients with AF and AS. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04645537.

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Section: Methodsmentioning

confidence: 99%

Aortic Stenosis and Outcomes in Patients With Atrial Fibrillation: A Nationwide Cohort Study

Teppo

Airaksinen

Biancari

et al. 2023

JAHA

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“…Follow-up continued until 31 December 2018 or death, whichever occurred first. The current sub-study was conducted within a cohort of patients with incident AF, established in previous studies of the FinACAF cohort [ 19 , 20 , 21 ]. In this cohort, patients with a recorded AF diagnosis during 2004–2006 were excluded because the 2-year medical history was considered too short to exclude the presence of an AF diagnosis before the cohort entry.…”

Section: Methodsmentioning

confidence: 99%

Rural–Urban differences in Use of Rhythm Control Therapies in Patients with Incident Atrial Fibrillation: A Finnish Nationwide Cohort Study

Teppo

Jaakkola

Biancari

et al. 2022

IJERPH

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Background: Rural–urban disparities have been reported in the access, utilization, and quality of healthcare. We aimed to assess whether use of antiarrhythmic therapies (AATs) in patients with atrial fibrillation (AF) differs between those with rural and urban residence. Methods: The registry-based FinACAF cohort covers all patients with AF from all levels of care in Finland. Patients were divided into rural and urban categories and into urbanization degree tertiles based on their municipality of residence at the time of AF diagnosis. The primary outcome was the use of any AAT, including cardioversion, catheter ablation, and fulfilled antiarrhythmic drug (AAD) prescription. Results: We identified 177,529 patients (49.9% female, mean age 73.0 (SD13.0) years) with incident AF during 2010–2018. Except for AADs, the differences in AAT use were nonsignificant when patients were stratified according to the rural–urban classification system (urban vs. rural adjusted incidence rate ratios (aIRRs) with 95% CIs for any AAT 1.01 (0.99–1.03), AADs 1.11 (1.07–1.15), cardioversion 1.01 (0.98–1.03), catheter ablation 1.05 (0.98–1.12)). However, slightly higher use of all rhythm control modalities was observed in the highest urbanization degree tertile when compared to the lowest tertile (aIRRs with 95% Cis for any AAT 1.06 (1.03–1.08), AADs 1.18 (1.14–1.23), cardioversion 1.05 (1.02–1.08), catheter ablation 1.10 (1.02–1.19)). Conclusions: This nationwide retrospective cohort study observed that urban residence is associated with higher use of AADs in patients with incident AF. Otherwise, the observed disparities were only marginal, suggesting that in the use of rhythm control therapies, no large rural–urban inequity exists in Finland.

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“…In this way, many biochemical biomarkers have been previously described, but they are not entirely useful due to lack of specificity or the timespan gaps in some protein biomarkers dynamics (especially those related to changes that occur after thrombolytic therapy) [ 13 , 14 ]. However, acute ischemic stroke pathophysiology has multiple components, and molecular biomarkers, such as thromboembolic component, inflammatory component, oxidative stress, and metabolic component, could be found in any of them [ 15 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

The Role of Potential Oxidative Biomarkers in the Prognosis of Acute Ischemic Stroke and the Exploration of Antioxidants as Possible Preventive and Treatment Options

Zahra

Lefter

Jaber

et al. 2023

IJMS

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Ischemic strokes occur when the blood supply to a part of the brain is interrupted or reduced due to arterial blockage, and it often leads to damage to brain cells or death. According to a myriad of experimental studies, oxidative stress is an important pathophysiological mechanism of ischemic stroke. In this narrative review, we aimed to identify how the alterations of oxidative stress biomarkers could suggest a severity-reflecting diagnosis of ischemic stroke and how these interactions may provide new molecular targets for neuroprotective therapies. We performed an eligibility criteria-based search on three main scientific databases. We found that patients with acute ischemic stroke are characterized by increased oxidative stress markers levels, such as the total antioxidant capacity, F2-isoprostanes, hydroxynonenal, total and perchloric acid oxygen radical absorbance capacity (ORACTOT and ORACPCA), malondialdehyde (MDA), myeloperoxidase, and urinary 8-oxo-7,8-dihydro-2′-deoxyguanosine. Thus, acute ischemic stroke is causing significant oxidative stress and associated molecular and cellular damage. The assessment of these molecular markers could be useful in diagnosing ischemic stroke, finding its causes, predicting its severity and outcomes, reducing its impact on the cellular structures of the brain, and guiding preventive treatment towards antioxidant-based therapy as novel therapeutic alternatives.

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Mental health conditions and risk of first‐ever ischaemic stroke and death in patients with incident atrial fibrillation: A nationwide cohort study

Cited by 9 publications

References 36 publications

Aortic Stenosis and Outcomes in Patients With Atrial Fibrillation: A Nationwide Cohort Study

Aortic Stenosis and Outcomes in Patients With Atrial Fibrillation: A Nationwide Cohort Study

Rural–Urban differences in Use of Rhythm Control Therapies in Patients with Incident Atrial Fibrillation: A Finnish Nationwide Cohort Study

The Role of Potential Oxidative Biomarkers in the Prognosis of Acute Ischemic Stroke and the Exploration of Antioxidants as Possible Preventive and Treatment Options

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