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

Abstract

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.

Clinical analysis of antithrombotic treatment and occurrence of stroke in elderly patients with nonvalvular persistent atrial fibrillation

“…With the development of global population aging, its prevalence is expected to increase 3‐fold in the next three decades . AF was associated with an increasing risk of mortality and morbidity from stroke, which seriously affected the quality of life of patients . The data from the 1980s to 1990s estimated that 16% of ischemic strokes were associated with AF.…”

Approach to the wide QRS-complex tachycardia

“…In our case, the patient was treated with intravenous amiodarone, which is the drug of choice in the cases of WCT of unknown etiology in hemodynamically stable patients, because it can terminate both VT and SVT [15,16]. Simultaneously, unfractionated heparin was administered to prevent cerebral thromboembolism, since it is known that those who have AF are five times more likely to suffer from stroke, regardless of the type of AF [17].…”

Association of smoking cessation after atrial fibrillation diagnosis on the risk of cardiovascular disease: a cohort study of South Korean men

“…AF was defined as either a hospitalization or two or more outpatient department visits under the diagnosis of AF [15]. Upon hospital use, the NHIS requires physicians to enter a diagnosis for all patients using the International Classification of Diseases, Tenth Revision (ICD-10) codes.…”