Stroke and death in elderly patients with atrial fibrillation in Japan compared with the United Kingdom

Senoo, Keitaro; An, Yoshimori; Ogawa, Hisashi; Lane, Deirdre A.; Wolff, A.; Shantsila, Eduard; Akao, Masaharu; Lip, Gregory Y.H.

doi:10.1136/heartjnl-2016-309741

Cited by 18 publications

(14 citation statements)

References 20 publications

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“…In contrast, Asian race was associated with lower risks of death and bleeding, without an excess of stroke/SE compared with non-Asian races. Conflicting observations were previously reported on this issue with the risks of death, stroke/SE, and bleeding found to be identical or higher in Asians compared to non-Asians [ 27 , 28 ]. In this report, these observations may be due to confounding factors despite adjustment, as these patients were at lower risk than non-Asian patients, as shown by their younger median age, lower rate of comorbidities, particularly CKD, and lower CHA 2 DS 2 -VASc score.…”

Section: Discussionmentioning

confidence: 88%

Risk factors for death, stroke, and bleeding in 28,628 patients from the GARFIELD-AF registry: Rationale for comprehensive management of atrial fibrillation

et al. 2018

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BackgroundThe factors influencing three major outcomes–death, stroke/systemic embolism (SE), and major bleeding–have not been investigated in a large international cohort of unselected patients with newly diagnosed atrial fibrillation (AF).Methods and resultsIn 28,628 patients prospectively enrolled in the GARFIELD-AF registry with 2-year follow-up, we aimed at analysing: (1) the variables influencing outcomes; (2) the extent of implementation of guideline-recommended therapies in comorbidities that strongly affect outcomes. Median (IQR) age was 71.0 (63.0 to 78.0) years, 44.4% of patients were female, median (IQR) CHA2DS2-VASc score was 3.0 (2.0 to 4.0); 63.3% of patients were on anticoagulants (ACs) with or without antiplatelet (AP) therapy, 24.5% AP monotherapy, and 12.2% no antithrombotic therapy. At 2 years, rates (95% CI) of death, stroke/SE, and major bleeding were 3.84 (3.68; 4.02), 1.27 (1.18; 1.38), and 0.71 (0.64; 0.79) per 100 person-years. Age, history of stroke/SE, vascular disease (VascD), and chronic kidney disease (CKD) were associated with the risks of all three outcomes. Congestive heart failure (CHF) was associated with the risks of death and stroke/SE. Smoking, non-paroxysmal forms of AF, and history of bleeding were associated with the risk of death, female sex and heavy drinking with the risk of stroke/SE. Asian race was associated with lower risks of death and major bleeding versus other races. AC treatment was associated with 30% and 28% lower risks of death and stroke/SE, respectively, compared with no AC treatment. Rates of prescription of guideline-recommended drugs were suboptimal in patients with CHF, VascD, or CKD.ConclusionsOur data show that several variables are associated with the risk of one or more outcomes, in terms of death, stroke/SE, and major bleeding. Comprehensive management of AF should encompass, besides anticoagulation, improved implementation of guideline-recommended therapies for comorbidities strongly associated with outcomes, namely CHF, VascD, and CKD.Trial registrationClinicalTrials.gov NCT01090362

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Section: Discussionmentioning

confidence: 88%

Risk factors for death, stroke, and bleeding in 28,628 patients from the GARFIELD-AF registry: Rationale for comprehensive management of atrial fibrillation

et al. 2018

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“…13 Although elderly adults with AF are more likely to benefit from OAC than younger individuals, 14 OACs may be underused in elderly adults. [15][16][17][18] Most clinical trials have not specifically addressed very elderly adults, and most study subjects are not representative of those aged 80 and older. Although current data from studies targeting older adults indicate that proper treatment planning and specific geriatric assessment can result in a safe treatment of older adults, 19,20 the use of OACs and adherence to guidelines in elderly adults varies in national and multinational registries.…”

Section: Discussionmentioning

confidence: 99%

Real‐World Clinical Characteristics and Treatment Patterns of Individuals Aged 80 and Older with Nonvalvular Atrial Fibrillation: Results from the ReAl‐life Multicenter Survey Evaluating Stroke Study

Biteker

Başaran

Doğan

et al. 2017

J American Geriatrics Society

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Nearly one-fifth of individuals with NVAF in this real-world sample were aged 80 and older. Participants aged 80 and older were more likely to be female and have more comorbidities than those who were younger than 80. Those aged 80 and older with AF were less likely to receive anticoagulants than those who were younger than 80, but having more comorbidities and other individual-level characteristics may explain this difference. When they were prescribed OACs, participants aged 80 and older had poorer quality of anticoagulation than those who were younger, suggesting opportunities for improvement.

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“…All patients with known vital status in March 2013 were eligible for inclusion. Majority of the AF patients in the Darlington Registry were Caucasian (over 96%) 16 . Data collection of this study was performed with GRASP-AF (Guidance on Risk Assessment and Stroke Prevention in Atrial Fibrillation) audit tool, which can interrogate primary care database with a pre-defined set of search criteria.…”

Section: Methodsmentioning

confidence: 99%

One-year risks of stroke and mortality in patients with atrial fibrillation from different clinical settings: The Gulf SAFE registry and Darlington AF registry

Miyazawa

Wolff

et al. 2019

International Journal of Cardiology

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Background: AF patients from different clinical settings may have varying outcomes. We aimed to provide patient-level comparisons using two cohorts of patients with AF from different settings. Methods: The clinical characteristics, prescription of OAC, one-year risks of stroke and mortality were compared between patients with AF included into the Darlington AF registry (general practice-based cohort from the United Kingdom, n=2258) and the Gulf SAFE (Survey of atrial fibrillation events) registry (emergency room-based cohort from the Gulf countries, n=1740). Results: Patients from the Gulf SAFE registry were younger, had high prevalence of diabetes, vascular disease, heart failure. Patients from the Darlington registry had higher prevalence of hypertension, previous thromboembolism event, and higher mean stroke risk. OAC use was <60% in high stroke risk patients in both registries. On multivariate analyses, patients from Gulf SAFE were independently associated with higher risks of stroke (odds ratio, 2.18 [1.47-3.23]) and mortality (odds ratio, 1.67 [1.31-2.14]), especially in those with high CHA 2 DS 2-VASc score (≥2 in males, ≥3 in females) (Darlington vs. Gulf SAFE: 3.51% vs. 5.63 for stroke; 11.4% vs. 16.8% for mortality) Conclusions: Differences regarding AF patients profile, OAC use and outcomes exist in varying clinical settings as reflected by registries from different origins. Tailored AF management strategy are needed to fit in different clinical settings.

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Stroke and death in elderly patients with atrial fibrillation in Japan compared with the United Kingdom

Abstract: Elderly (age ≥75 years) patients with AF in both Japan and the UK are at similarly high risk of stroke and death, with OAC still underused in both populations. Ethnicity was not independently associated with the risk of stroke, regardless of OAC use or non-use.

Cited by 18 publications

References 20 publications

Risk factors for death, stroke, and bleeding in 28,628 patients from the GARFIELD-AF registry: Rationale for comprehensive management of atrial fibrillation

Risk factors for death, stroke, and bleeding in 28,628 patients from the GARFIELD-AF registry: Rationale for comprehensive management of atrial fibrillation

Real‐World Clinical Characteristics and Treatment Patterns of Individuals Aged 80 and Older with Nonvalvular Atrial Fibrillation: Results from the ReAl‐life Multicenter Survey Evaluating Stroke Study

One-year risks of stroke and mortality in patients with atrial fibrillation from different clinical settings: The Gulf SAFE registry and Darlington AF registry

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