Occurrence of death and stroke in patients in 47 countries 1 year after presenting with atrial fibrillation: a cohort study

Healey, Jeff S.; Oldgren, Jonas; Ezekowitz, Michael D.; Zhu, Jun; Пайс, Прем; Jia, Wang; Commerford, Patrick; Jánský, Petr; Avezum, Álvaro; Sigamani, Alben; Damasceno, Albertino; Reilly, Paul; Grinvalds, Alex; Nakamya, Juliet; Aje, Akinyemi; Almahmeed, Wael; Moriarty, Andrew; Wallentin, Lars; Yusuf, Salim; Connolly, Stuart J.

doi:10.1016/s0140-6736(16)30968-0

Cited by 240 publications

(167 citation statements)

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“…The overall incidence of ischemic stroke in our patients with AF (30.8 per 1000 person-years) was higher than the ischemic stroke incidences in AF that were reported in other countries [7,17–19]: the ACTIVE W (Atrial Fibrillation Clopidogrel Trial With Irbesartan for Prevention of Vascular) study in Canada reported that the annualized risk of stroke in paroxysmal and sustained AF was 20 and 22 per 1000 person-years, respectively [17]. In Denmark, 11.28% of AF patients had a diagnosis of incident stroke in 1980–2002 [20].…”

Section: Discussioncontrasting

confidence: 67%

“…Our higher incidence of ischemic stroke may reflect the different race/ethnicity of our patients compared with those in the other studies. That race/ethnicity differences influence ischemic stroke rates in AF has been observed previously [7,8]. For example, Healey et al .…”

Section: Discussionsupporting

confidence: 60%

“…For example, Healey et al . showed that ischemic stroke rates of patients with AF varied between countries: the highest and lowest frequencies of strokes were found in patients in Africa (8%) and in India (<1%), respectively [7]. Another contributing factor may be our low OAC (warfarin) treatment rate.…”

Section: Discussionmentioning

confidence: 99%

“…Race/ethnicity influences the risk of stroke in patients with AF [7,8]: in whites, blacks, Hispanics, and Asians who are treated with warfarin, the ischemic stroke rates per 1000 person-years’ follow-up are 15.9, 27.1, 15.1, and 13.4, respectively [8], while the equivalent rates for subjects not using warfarin are 20.3, 29.4, 21.3, and 20.6 strokes per 1000 person-years, respectively. Moreover, Healey et al .…”

Section: Introductionmentioning

confidence: 99%

“…showed that rates of stroke occurrence within a year of presenting with AF at a hospital emergency department according to the countries were as follows: North America, Western Europe, or Australia (2%), South America (3%), Eastern Europe (4%), Southeast Asia (7%), China (7%), Africa (8%), and India (0.8%). The incidence of all-causes death within 1 year after presenting with AF also varies widely between these regions from 9% to 20% [7]. …”

Section: Introductionmentioning

confidence: 99%

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Risk of ischemic stroke after atrial fibrillation diagnosis: A national sample cohort

et al. 2017

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Atrial fibrillation (AF) is a major risk factor for ischemic stroke and associated with a 5-fold higher risk of stroke. In this retrospective cohort study, the incidence of and risk factors for ischemic stroke in patients with AF were identified. All patients (≥30 years old) without previous stroke who were diagnosed with AF in 2007–2013 were selected from the National Health Insurance Service-National Sample Cohort. To identify factors that influenced ischemic stroke risk, Cox proportional hazard regression analysis was conducted. During a mean follow-up duration of 3.2 years, 1022 (9.6%) patients were diagnosed with ischemic stroke. The overall incidence rate of ischemic stroke was 30.8/1000 person-years. Of all the ischemic stroke that occurred during the follow-up period, 61.0% occurred within 1-year after AF diagnosis. Of the patients with CHA2DS2-VASc score of ≥2, only 13.6% were receiving warfarin therapy within 30 days after AF diagnosis. Relative to no antithrombotic therapy, warfarin treatment for >90 days before the index event (ischemic stroke in stroke patients and death/study end in non-stroke patients) associated with decreased ischemic stroke risk (Hazard Ratio = 0.41, 95%confidence intervals = 0.32–0.53). Heart failure, hypertension, and diabetes mellitus associated with greater ischemic stroke risk. AF patients in Korea had a higher ischemic stroke incidence rate than patients in other countries and ischemic stroke commonly occurred at early phase after AF diagnosis. Long-term (>90 days) continuous warfarin treatment may be beneficial for AF patients. However, warfarin treatment rates were very low. To prevent stroke, programs that actively detect AF and provide anticoagulation therapy are needed.

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Section: Discussioncontrasting

confidence: 67%

Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk of ischemic stroke after atrial fibrillation diagnosis: A national sample cohort

et al. 2017

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Effect of Emergency Department Care Bundle on Elderly Patients With Acute Heart Failure

Liu

2021

JAMA

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Evaluation of the Risk of Stroke Without Anticoagulation Therapy in Men and Women With Atrial Fibrillation Aged 66 to 74 Years Without Other CHA₂DS₂-VASc Factors

et al. 2021

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IMPORTANCEThere are limited clinical trial data and discrepant recommendations regarding use of anticoagulation therapy in patients with atrial fibrillation (AF) aged 65 to 74 years without other stroke risk factors.OBJECTIVES To evaluate the risk of stroke without anticoagulation therapy in men and women with AF aged 66 to 74 years without other CHA 2 DS 2 -VASc (congestive heart failure, hypertension, age Ն75 years, diabetes, stroke, vascular disease, age 65-74 years, female sex) risk factors and examine the association of stroke incidence with patient age. DESIGN, SETTING, AND PARTICIPANTSA population-based retrospective cohort study was conducted using linked administrative databases. The population included 16 351 individuals aged 66 to 74 years who were newly diagnosed with AF in Ontario, Canada, between April 1, 2007, and March 31, 2017. Exclusion criteria included long-term care residence, prior anticoagulation therapy, valvular disease, heart failure, hypertension, diabetes, stroke, and vascular disease. The cumulative incidence function was used to estimate the 1-year incidence of stroke in patients who did not receive anticoagulation therapy. Fine-Gray regression was used to study the association of patient characteristics with stroke incidence and derive estimates of stroke risk at each age. Death was treated as a competing risk and patients were censored if they initiated anticoagulation therapy. Inverse probability of censoring weights was used to account for patient censoring. Data analysis was performed from May 26, 2019, to December 9, 2020. EXPOSURES Atrial fibrillation and age.MAIN OUTCOMES AND MEASURES Hospitalizations for stroke. RESULTSOf the 16 351 individuals with AF (median [interquartile range] age, 70 [68-72] years), 8352 (51.1%) were men; 6314 individuals (38.6%) started anticoagulation therapy during follow-up. The overall 1-year stroke incidence among patients who did not receive anticoagulation therapy was 1.1% (95% CI, 1.0%-1.3%) and the incidence of death without stroke was 8.1% (95% CI, 7.7%-8.5%). The incidence of stroke was not significantly associated with sex. The estimated 1-year stroke risk increased with patient age from 66 years (0.7%; 95% CI, 0.5%-0.9%) to 74 years (1.7%; 95% CI, 1.3%-2.1%). CONCLUSIONS AND RELEVANCEThe risk of stroke more than doubled in this study as men and women with AF but no other CHA 2 DS 2 -VASc risk factors aged from 66 to 74 years. These data suggest that anticoagulation therapy is more likely to benefit older individuals within this group of patients, whereas younger individuals are less likely to gain net clinical benefit from anticoagulation therapy.

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Occurrence of death and stroke in patients in 47 countries 1 year after presenting with atrial fibrillation: a cohort study

Cited by 240 publications

References 40 publications

Risk of ischemic stroke after atrial fibrillation diagnosis: A national sample cohort

Risk of ischemic stroke after atrial fibrillation diagnosis: A national sample cohort

Effect of Emergency Department Care Bundle on Elderly Patients With Acute Heart Failure

Evaluation of the Risk of Stroke Without Anticoagulation Therapy in Men and Women With Atrial Fibrillation Aged 66 to 74 Years Without Other CHA₂DS₂-VASc Factors

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Occurrence of death and stroke in patients in 47 countries 1 year after presenting with atrial fibrillation: a cohort study

Cited by 240 publications

References 40 publications

Risk of ischemic stroke after atrial fibrillation diagnosis: A national sample cohort

Risk of ischemic stroke after atrial fibrillation diagnosis: A national sample cohort

Effect of Emergency Department Care Bundle on Elderly Patients With Acute Heart Failure

Evaluation of the Risk of Stroke Without Anticoagulation Therapy in Men and Women With Atrial Fibrillation Aged 66 to 74 Years Without Other CHA2DS2-VASc Factors

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Product

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Evaluation of the Risk of Stroke Without Anticoagulation Therapy in Men and Women With Atrial Fibrillation Aged 66 to 74 Years Without Other CHA₂DS₂-VASc Factors