Prevalence of Atrial Fibrillation and Association of Atrial Fibrillation with Prior and New Thromboembolic Stroke in Older Patients

Aronow, Wilbert S.; Ahn, Chul; Gutstein, Hal

doi:10.1111/j.1532-5415.1996.tb01436.x

Cited by 80 publications

(65 citation statements)

References 13 publications

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“…Impact of atrial fibrillation on mortality in patients with heart failure has been variously described [7][8][9]. Using the same dataset, we previously reported among geriatric heart failure patients that the presence of atrial fibrillation was associated with a 52% increased risk of 4-year mortality (adjusted hazard ratio, 1.52; 95% confidence interval, 1.11-2.07).…”

Section: Resultsmentioning

confidence: 92%

Incident atrial fibrillation and mortality in older adults with heart failure

Ahmed

Perry

2005

European J of Heart Fail

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We studied 944 hospitalized heart failure patients 65 years and older to examine the impact of incident atrial fibrillation on mortality. Patients were categorized into four groups based on past medical history and admission electrocardiogram: (1) no (neither past nor current), (2) incident (newly diagnosed), (3) past and (4) chronic (past and current) atrial fibrillation. The primary outcome was 4-year all-cause mortality. Bivariate and multivariable Cox proportion hazards analyses were used to determine risk of all-cause mortality. In the multivariable model, we adjusted for various demographic and clinical covariates. Compared with patients who never had atrial fibrillation, those with incident atrial fibrillation had a 57% higher risk of death (unadjusted hazard ratio, 1.57; 95% confidence interval, 1.22-2.03). After adjustment for other covariates the association remained unchanged (adjusted hazard ratio, 1.41; 95% confidence interval, 1.08-1.83). Past or chronic atrial fibrillation was not associated with increased risk of death.

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Section: Resultsmentioning

confidence: 92%

Incident atrial fibrillation and mortality in older adults with heart failure

Ahmed

Perry

2005

European J of Heart Fail

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“…A previous cerebrovascular accident, however, led to a significant and more than threefold increased risk of a new cerebrovascular event in patients with chronic atrial fibrillation, which is in line with the findings of an earlier study. 17 Patients who have previously suffered a cerebrovascular accident are at high risk of stroke, physical and intellectual disability, long-term institutionalization and premature death. 18 However, much can be done to reduce the risk of ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

Risk of Cerebrovascular Accident After a First Diagnosis of Atrial Fibrillation

Ruigómez

Rodrı́guez

Johansson

et al. 2007

Clinical Cardiology

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SummaryBackground: Atrial fibrillation is the most common cardiac arrhythmia and a major risk factor for cerebrovascular accident, including ischemic stroke and transient ischemic attack.Hypothesis: Ischemic cerebrovascular accident is associated with increasing age and cardiovascular and cerebrovascular disease in primary care patients with atrial fibrillation.Methods: Using the U.K. General Practice Research Database, we identified patients with chronic atrial fibrillation who were alive 1 month after initial diagnosis (n = 906). Potential cases of cerebrovascular accident were identified and confirmed by the primary care physician. The incidence of cerebrovascular accident was calculated. A nested case-control analysis was performed to identify factors associated with cerebrovascular accident among patients with chronic atrial fibrillation.Results: During a mean follow-up period of 1.8 years (range: 0-3.9 years), 60 patients with atrial fibrillation were diagnosed with a new cerebrovascular accident (22 cases with transient ischemic attack and 38 with ischemic stroke). The incidence of new cerebrovascular accident was 3.6 per 100 patient-years (95% confidence interval

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“…Both hypertension and atrial fibrillation are associated with an increased incidence of stroke, heart failure, and mortality (1)(2)(3). Hypertension and left ventricular hypertrophy caused by hypertension are major risk factors for atrial fibrillation (1).…”

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Hypertension associated with atrial fibrillation

Aronow¹

2017

Ann. Transl. Med.

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Hypertension (1) and atrial fibrillation (2,3) both increase with age. Both hypertension and atrial fibrillation are associated with an increased incidence of stroke, heart failure, and mortality (1-3). Hypertension and left ventricular hypertrophy caused by hypertension are major risk factors for atrial fibrillation (1). Hypertension is present in more than 80% of patients with atrial fibrillation (4). At 44-month follow-up of 2,384 older patients, atrial fibrillation was a significant risk factor for new thromboembolic stroke with a risk ratio of 3.2, and left ventricular hypertrophy associated with hypertension was a significant independent risk factor for thromboembolic stroke with a risk ratio of 2.8 (5). At 36-month follow-up of 312 older patients with chronic atrial fibrillation, left ventricular hypertrophy associated with hypertension was a significant independent risk factor for thromboembolic stroke with a risk ratio of 2.8 (6). Hypertension is one of the risk factors for development of thromboembolic stroke in patients with atrial fibrillation in the CHADS 2 (7) and CHA 2 DS 2 -VASc (8) scoring systems for risk of stroke. Hypertension is present in 74% of patients with congestive heart failure and in 77% of patients with a first stroke (9). Atrial fibrillation was present in 37% of 355 patients, mean age 80 years, with prior myocardial infarction, congestive heart failure, and a reduced left ventricular ejection fraction and in 33% of 296 patients, mean age 82 years, with prior myocardial infarction, congestive heart failure, and a preserved left ventricular ejection fraction (10).Hypertension is associated with left ventricular hypertrophy, impaired diastolic filling of the left ventricle, increased left atrial pressure, left atrial hypertrophy and enlargement, increased atrial fibrosis, increased atrial ectopic activity, and slowing of intra-and interatrial electrical conduction velocities (11). These changes in cardiac structure and physiology predispose to atrial fibrillation developing and increasing the risk of thromboembolic events (11). In patients who have atrial fibrillation, the presence of hypertension increases the incidence of stroke by an additional 2 to 3 times (12,13).Adequate control of hypertension is indicated to reduce the risk of developing atrial fibrillation. A meta-analysis was performed in 11 randomized studies including 56,308 patients which investigated whether treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers reduced the development of atrial fibrillation (14). The studies included four trials of patients with congestive heart failure, three trials of patients with hypertension, two trials after cardioversion for atrial fibrillation, and two trials after myocardial infarction. Overall, the use of angiotensin-converting enzyme inhibitors significantly reduced the risk of developing atrial fibrillation by 28%, and the use of angiotensin receptor blockers significantly reduced the risk of developing atrial fibrillation by 29%. The preve...

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Prevalence of Atrial Fibrillation and Association of Atrial Fibrillation with Prior and New Thromboembolic Stroke in Older Patients

Abstract: Atrial fibrillation, prior TE stroke, and male sex are independent risk factors for the development of new TE stroke in older patients.

Cited by 80 publications

References 13 publications

Incident atrial fibrillation and mortality in older adults with heart failure

Incident atrial fibrillation and mortality in older adults with heart failure

Risk of Cerebrovascular Accident After a First Diagnosis of Atrial Fibrillation

Hypertension associated with atrial fibrillation

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