Risk of Ischemic Stroke in Patients With Non-Valvular Atrial Fibrillation Not Receiving Oral Anticoagulants　― Korean Nationwide Population-Based Study ―

Kang, Si Hyuck; Choi, Eue Keun; Han, Kyungdo; Lee, So‐Ryoung; Lim, Woo Hyun; Cha, Myung‐Jin; Cho, Youngjin; Oh, Il-Young; Oh, Seil

doi:10.1253/circj.cj-16-1267

Cited by 39 publications

(29 citation statements)

References 34 publications

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“…We found that more than 75% of men with a CHA 2 DS 2 -VASc score of 1 were undertreated with OAC therapy. In our previous study, we reported that men with a CHA 2 DS 2 -VASc score of 1 were still at high stroke risk, at 1.47% per 100 person-years [ 21 ]. Based on the Taiwan nationwide data, the annual stroke rate was 2.75% in men with AF and CHA 2 DS 2 -VASc score of 1 and 2.55% in females with score 2, namely patients with one non-gender related stroke risk factor [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…Heart failure, prior stroke/transient ischemic attack (TIA)/systemic thromboembolism (TE), prior myocardial infarction (MI), peripheral artery disease (PAD), and prior intracranial hemorrhage (ICH) were also defined using ICD-10-CM codes. The definition of these comorbidities has been validated in previous studies based on the NHIS cohort [ 6 , 17 – 21 ].…”

Section: Methodsmentioning

confidence: 99%

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Temporal trends of antithrombotic therapy for stroke prevention in Korean patients with non-valvular atrial fibrillation in the era of non-vitamin K antagonist oral anticoagulants: A nationwide population-based study

Lee¹,

Choi²,

Han³

et al. 2017

PLoS ONE

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BackgroundFollowing their introduction, the non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly prescribed in Asia for stroke prevention in patients with non-valvular atrial fibrillation (AF). Few contemporary data are available on temporal trends in antithrombotic therapy use in Asian countries, in the era of NOACs.Methods and resultsUsing the National Health Insurance Service database of the entire Korean adult AF population, the use of aspirin, vitamin K antagonist, and NOACs between 2008 and 2015 were analyzed (n = 276,246 in 2015). Most of the included cohort had CHA2DS2-VASc score ≥ 2 (78.2% in 2008 and 83.2% in 2015), yet approximately 17% were prescribed no antithrombotic therapy throughout the study period. Aspirin prescription consistently decreased (from 48.2% to 31.5%) over time, while OAC prescription significantly increased from 34.7% to 50.6%. NOAC prescriptions accounted for 50% of total OAC prescription in 2015. Similar trends in antithrombotic therapy were found both in men and in women, but women were more likely to be undertreated with OAC. Female gender, presence of vascular disease and prior intracranial hemorrhage were associated with OAC underuse.ConclusionsBetween 2008 and 2015, a greater proportion of AF patients received OAC treatment with increasing NOAC prescription trends in the recent 3 years. A substantial proportion (approx. 50%) of Korean patients with AF still remain undertreated.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Temporal trends of antithrombotic therapy for stroke prevention in Korean patients with non-valvular atrial fibrillation in the era of non-vitamin K antagonist oral anticoagulants: A nationwide population-based study

Lee¹,

Choi²,

Han³

et al. 2017

PLoS ONE

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“…The primary endpoint was newly diagnosed ischemic stroke. This variable was defined as diagnosis of ischemic stroke (I63-64) given during hospitalization combined with claims for neurologic imaging by computed tomography or magnetic resonance[ 18 , 29 , 30 ]. Patients who did not develop ischemic stroke during the follow-up period were censored on the day of drop-out (due to death or emigration) or at the end of follow-up.…”

Section: Methodsmentioning

confidence: 99%

Risk of ischemic stroke in metabolically healthy obesity: A nationwide population-based study

et al. 2018

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BackgroundWhether metabolically healthy obese (MHO) individuals are at increased risk of ischemic stroke is not well known. We investigated the association of the MHO phenotype with ischemic stroke.MethodsA total of 354,083 adults (age 45.8 ± 14.2 years) from the Korean National Health Insurance Service–National Sample Cohort enrolled in 2004–2008 were followed-up for incident ischemic stroke until 2013. Subjects meeting none of the metabolic syndrome criteria were classified as ‘metabolically healthy’. The cohort was categorized into four groups according to obesity and metabolic status: metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), MHO, and metabolically unhealthy obese (MUO).ResultsIschemic stroke was newly diagnosed in 4,884 (1.4%) individuals during a mean follow-up of 7.4 ± 1.5 years. Stroke incidence rates for the MHNW, MUNW, MHO, and MUO groups were 0.56, 2.61, 0.61, and 2.76 per 1,000 person-years, respectively. While risk for stroke increased significantly in metabolically unhealthy groups, it was not increased in MHO compared to the MHNW group on multivariate analysis. In metabolically healthy individuals, obesity did not increase the risk for ischemic stroke, regardless of the severity of obesity. Meanwhile, in metabolically unhealthy individuals, being obese was significantly associated with increased risk of stroke.ConclusionsMHO individuals were not at increased risk for ischemic stroke. However, obesity increased risk for ischemic stroke in persons with metabolic risk factors; therefore, maintaining normal weight may be more important for this population. Also, metabolic unhealthiness showed greater association than obesity with stroke.

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“…All definitions of AF and other comorbidities have already been validated by previous studies from the NHIS claim database. 7) 21) 22) 23) 24) …”

Section: Methodsmentioning

confidence: 99%

Prevalence of Non-valvular Atrial Fibrillation Based on Geographical Distribution and Socioeconomic Status in the Entire Korean Population

et al. 2018

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Background and ObjectivesPrevalence of atrial fibrillation (AF) varies based on geographical location and socioeconomic status. We aimed to evaluate the prevalence of AF and utilization of antithrombotic therapy based on geographical regions and income levels in the entire Korean population.MethodsWe performed a cross-sectional analysis of Korean adults (aged ≥20 years) using the 2015 National Health Insurance Service database (n=41,505,679). The study population was stratified into 17 geographical regions and 21 income levels.ResultsWe identified 276,842 patients diagnosed with AF. Overall prevalence of AF in suburban/rural regions was significantly higher than that observed in urban regions (0.72% vs. 0.61%, respectively, p<0.001). Elderly patients (age ≥75 years) showed a higher prevalence of AF and comorbidities related to AF development showed a higher prevalence among the population residing in suburban/rural regions. Among AF patients with a CHA2DS2-VASc score ≥2, oral anticoagulation (OAC) therapy utilization was lower in the suburban/rural regions than that observed in the urban regions (48.2% vs. 51.8%, respectively, p<0.001). The relationship between income levels and AF prevalence showed a J-shaped curve. The OAC prescription rate showed a positive correlation with income levels. Non-vitamin K antagonist oral anticoagulants tended to be more commonly prescribed among the higher income groups.ConclusionsGeographical location of residence and income levels were closely associated with the prevalence of AF and antithrombotic therapy utilization. This information may provide further insights for more effective surveillance of AF and stroke prevention for improved clinical outcomes.

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Risk of Ischemic Stroke in Patients With Non-Valvular Atrial Fibrillation Not Receiving Oral Anticoagulants　― Korean Nationwide Population-Based Study ―

Cited by 39 publications

References 34 publications

Temporal trends of antithrombotic therapy for stroke prevention in Korean patients with non-valvular atrial fibrillation in the era of non-vitamin K antagonist oral anticoagulants: A nationwide population-based study

Temporal trends of antithrombotic therapy for stroke prevention in Korean patients with non-valvular atrial fibrillation in the era of non-vitamin K antagonist oral anticoagulants: A nationwide population-based study

Risk of ischemic stroke in metabolically healthy obesity: A nationwide population-based study

Prevalence of Non-valvular Atrial Fibrillation Based on Geographical Distribution and Socioeconomic Status in the Entire Korean Population

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Risk of Ischemic Stroke in Patients With Non-Valvular Atrial Fibrillation Not Receiving Oral Anticoagulants ― Korean Nationwide Population-Based Study ―

Cited by 39 publications

References 34 publications

Temporal trends of antithrombotic therapy for stroke prevention in Korean patients with non-valvular atrial fibrillation in the era of non-vitamin K antagonist oral anticoagulants: A nationwide population-based study

Temporal trends of antithrombotic therapy for stroke prevention in Korean patients with non-valvular atrial fibrillation in the era of non-vitamin K antagonist oral anticoagulants: A nationwide population-based study

Risk of ischemic stroke in metabolically healthy obesity: A nationwide population-based study

Prevalence of Non-valvular Atrial Fibrillation Based on Geographical Distribution and Socioeconomic Status in the Entire Korean Population

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Risk of Ischemic Stroke in Patients With Non-Valvular Atrial Fibrillation Not Receiving Oral Anticoagulants　― Korean Nationwide Population-Based Study ―