Non-permanent atrial fibrillation and oral anticoagulant therapy are related to survival during 10 years after first-ever ischemic stroke

Baturova, Maria; Lindgren, Arne; Carlson, Jonas; Shubik, Yuri V.; Olsson, Sandra; Platonov, Pyotr G.

doi:10.1016/j.ijcard.2017.01.040

Cited by 5 publications

(12 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, we extracted data from a total of 26 studies, reporting outcomes on 23,054 patients. 15–40 Figure 1 shows the process of study selection. Table 1 presents the baseline characteristics of included studies.…”

Section: Resultsmentioning

confidence: 99%

The impact of atrial fibrillation type on the risks of thromboembolic recurrence, mortality and major haemorrhage in patients with previous stroke: A systematic review and meta-analysis of observational studies

Mentel

Quinn

Cameron

et al. 2020

European Stroke Journal

View full text Add to dashboard Cite

Introduction There is conflicting evidence on the impact of atrial fibrillation (AF) type, i.e. non-paroxysmal AF or paroxysmal AF, on thromboembolic recurrence. The consensus of risk equivalence is greatly based on historical evidence, focussing on initial stroke risks. We conducted a systematic review and meta-analysis to describe the impact of AF type on the risk of thromboembolic recurrence, mortality and major haemorrhage in patients with previous stroke. Methods We systematically searched four multidisciplinary databases from inception to December 2018. We selected observational studies investigating clinical outcomes in patients with ischaemic stroke and AF, stratified by AF type. We assessed all included studies for risk of bias using the ‘Risk of Bias In Non-randomised Studies – of Exposures’ tool. The Comprehensive Meta-Analysis Software was used to calculate odds ratios from crude event rates. Results After reviewing 14,127 citations, we selected 108 studies for full-text screening. We extracted data from a total of 26 studies, reporting outcomes on 23,054 patients. Overall, risk of bias was moderate. The annual incidence rates of thromboembolism in patients with non-paroxysmal AF and paroxysmal AF were 7.1% (95% confidence interval: 4.2–11.7) and 5.2% (95% confidence interval: 3.2–8.2), respectively. The odds ratio for thromboembolism in patients with non-paroxysmal AF versus paroxysmal AF was 1.47 (95% confidence interval: 1.08–1.99, p = 0.013). The annual mortality rates in patients with non-paroxysmal AF and paroxysmal AF were 20.0% (95% confidence interval: 13.2–28.0) and 10.1% (95% confidence interval: 5.4–17.3), respectively, and odds ratio was 1.90 (95% confidence interval: 1.43–2.52, p < 0.001). There was no difference in rates of major haemorrhage, odds ratio = 1.01 (95% confidence interval: 0.61–1.69, p = 0.966). Conclusion In patients with prior stroke, non-paroxysmal AF is associated with significantly higher risk of thromboembolic recurrence and mortality than paroxysmal AF. Although current guidelines make no distinction between non-paroxysmal AF and paroxysmal AF for secondary stroke prevention, future guidance and risk stratification tools may need to consider this differential risk (PROSPERO ID: CRD42019118531).

show abstract

Section: Resultsmentioning

confidence: 99%

The impact of atrial fibrillation type on the risks of thromboembolic recurrence, mortality and major haemorrhage in patients with previous stroke: A systematic review and meta-analysis of observational studies

Mentel

Quinn

Cameron

et al. 2020

European Stroke Journal

View full text Add to dashboard Cite

show abstract

“…The median duration of follow-up was 9 (IQR 4–10) years. Dates of death, primary and secondary diagnoses on the date of death were determined via record linkage with the Swedish Causes of Death Register as reported previously [10]. The endpoint in this study was defined as all-cause mortality.…”

Section: Methodsmentioning

confidence: 99%

“…Oral anticoagulant (OAC) therapy at discharge and during the 10-year follow-up was ascertained using the Lund University Hospital anticoagulation database, which contains data for all patients in the hospital’s local catchment area receiving OAC [10]. Non-vitamin K antagonist oral anticoagulants were not available at the time of enrollment in the LSR, so in our study OAC therapy was limited to the use of warfarin.…”

Section: Methodsmentioning

confidence: 99%

“…Hazards proportional assumption was checked using graphical method generating log minus log plot. In multivariate Cox regression analyses we included age, gender, cardiac failure, hypertension, non-permanent AF, vascular disease, diabetes, severity of stroke measured by NIHSS scale and smoking status, the factors known to be associated with all-cause mortality in stroke survivors [10, 11].…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Interatrial block in prediction of all-cause mortality after first-ever ischemic stroke

Baturova

Lindgren

Shubik

et al. 2019

BMC Cardiovasc Disord

Self Cite

View full text Add to dashboard Cite

BackgroundInteratrial block (IAB) is an ECG indicator of atrial fibrosis related to atrial remodeling and thrombus formation thus leading to embolic stroke and increasing mortality. We aimed to assess weather IAB predicted all-cause mortality during 10 years after ischemic stroke.MethodsThe study sample comprised 235 patients (median age 74 (interquartile range 25–75% 65–81) years, 95 female) included in the Lund Stroke Register in 2001–2002, who had sinus rhythm ECGs at stroke admission. IAB was defined as a P-wave duration ≥120 ms without = partial IAB (n = 56) or with = advanced IAB (n = 41) biphasic morphology (±) in the inferior ECG leads. All-cause mortality was assessed via linkage with the Swedish Causes of Death Register.ResultsDuring follow-up 126 patients died (54%). Advanced IAB, but not partial, was associated with all-cause mortality in univariate Cox regression analysis (hazard ratio (HR) 1.98, 95% CI 1.27–3.09, p = 0.003). After adjustment for age, gender, severity of stroke measured by NIHSS scale and smoking status in patients without additional comorbidities advanced IAB independently predicted all-cause mortality (HR 7.89, 95% CI 2.01–30.98, p = 0.003), while in patients with comorbidities it did not (HR 1.01 95% CI 0.59–1.72, p = 0.966).ConclusionAdvanced IAB predicted all-cause mortality after ischemic stroke, but mostly in patients without additional cardiovascular comorbidities.

show abstract

“…5 Overall, the rates of anticoagulation from the baseline and during the follow-up in the EMMA cohort were lower than those previously verified in most cohorts performed in high-income countries. [2][3][4] Despite the importance of approaching anticoagulation after a stroke event associated to AF, few studies, particularly in high-income countries, have evaluated mortality risk considering OAC therapy in a longer follow-up 12 , as we did. A Swedish prospective cohort, the Lund Stroke Register, reported that after 10 years of follow-up, AF was independently associated with higher risk of all-cause mortality, especially for those with permanent AF without OAC (HR 2.28; 95%CI: 1.38-3.77, p = 0.001).…”

Section: Af Related Stroke Outcomes and Anticoagulationmentioning

confidence: 99%

The impact of atrial fibrillation and long-term oral anticoagulant use on all-cause and cardiovascular mortality: A 12-year evaluation of the prospective Brazilian Study of Stroke Mortality and Morbidity

Goulart

Olmos

Santos

et al. 2021

International Journal of Stroke

View full text Add to dashboard Cite

Background: Atrial fibrillation (AF) is a predictor of poor prognosis after stroke. Aims: To evaluate AF and all-cause and cardiovascular (CVD) mortality in a stroke cohort with low socioeconomic status (SES), taking into consideration oral anticoagulant (OAC) use during 12-year follow-up. Methods: All-cause mortality was analyzed by Kaplan-Meier survival curve and Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (95%CI). For specific mortality causes, cumulative incidence functions were computed. A logit link function was used to calculate odds ratios (OR) with 95% CIs. Full models were adjusted by age, sex, OAC use (as a time-dependent variable) and cardiovascular risk factors. Results: Of 1,121 ischemic stroke (IS) participants, 17.8 % had AF. Overall, 654 deaths (58.3%) were observed. Survival rate was lower (median days, interquartile range-IQR) among those with AF (531, IQR: 46-2,039) vs. non-AF (1,808, IQR: 334-3,301), p-log rank <0.0001). Over 12-year follow-up, previous AF was associated with increased mortality: all-cause (multivariable HR, 1.82; 95%CI: 1.43-2.31) and CVD mortality (multivariable OR, 2.07; 95%CI: 1.36-3.14), but not stroke mortality. In the same multivariable models, OAC use was inversely associated with all-cause mortality (OAC time-dependent effect: multivariable HR, 0.47; 95%CI: 0.30-0.50, p=0.002) and stroke mortality (OAC time-dependent effect â¥ 6 months: multivariable OR, 0.09; 95% CI: 0.01-0.65, p-value=0.02), but not CVD mortality. Conclusions: Among individuals with low SES, AF was an independent predictor of poor survival, increasing all-cause and CVD mortality risk. Long-term OAC use was associated with a markedly reduced risk of all-cause and stroke mortality.

show abstract

Non-permanent atrial fibrillation and oral anticoagulant therapy are related to survival during 10 years after first-ever ischemic stroke

Cited by 5 publications

References 27 publications

The impact of atrial fibrillation type on the risks of thromboembolic recurrence, mortality and major haemorrhage in patients with previous stroke: A systematic review and meta-analysis of observational studies

The impact of atrial fibrillation type on the risks of thromboembolic recurrence, mortality and major haemorrhage in patients with previous stroke: A systematic review and meta-analysis of observational studies

Interatrial block in prediction of all-cause mortality after first-ever ischemic stroke

The impact of atrial fibrillation and long-term oral anticoagulant use on all-cause and cardiovascular mortality: A 12-year evaluation of the prospective Brazilian Study of Stroke Mortality and Morbidity

Contact Info

Product

Resources

About