Glycated hemoglobin and risk of first episode stroke in diabetic patients with atrial fibrillation: A cohort study

Saliba, Walid; Barnett‐Griness, Ofra; Elias, Mazen; Rennert, Gad

doi:10.1016/j.hrthm.2015.01.025

Cited by 43 publications

(32 citation statements)

References 27 publications

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“…In the 9 AF cohorts with at least 5000 patients not taking OAC8, 14, 15, 16, 17, 18, 19, 20, 21 identified in our systematic review, overall event rates ranged from 0.45% to 7.03% per year (median of 2.99% per year). Event rates differed markedly between national cohorts from adjacent geographic regions (eg, Sweden and Denmark) as well as cohorts from the same country (eg, the 2 Taiwanese cohorts) (Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…Though some studies did include AF diagnosis by ECG as 1 entry criterion,15, 17 none required an ECG for inclusion into the study and no cohort required review of original ECGs, and none validated the diagnosis by review of medical charts. Only 1 cohort specifically excluded transient AF and provided an estimate of the proportion with paroxysmal AF 17. Only the United Kingdom Clinical Practice Research Datalink cohort included exclusively incident AF (Table 3).…”

Section: Resultsmentioning

confidence: 99%

“…One study supplemented pharmacy records with international normalized ratio testing 17. The 2 Taiwan National Health Insurance Research Database studies excluded patients using antiplatelet agents (Table 3).…”

Section: Resultsmentioning

confidence: 99%

“…The Danish National Patient Registry required both an ICD‐10 code as well as use of a loop diuretic in the pharmacy database for the diagnosis of congestive heart failure, use of 2 antihypertensive medications from 2 separate medication classes to diagnose hypertension, and use of a glucose‐lowering drug to diagnose diabetes mellitus. All administrative database studies had average look‐back periods of 2 or more years8, 16, 17, 18, 21, 22 (Table 3). …”

Section: Resultsmentioning

confidence: 99%

“…The Israel Clalit study also included transient ischemic attack, the Danish National Patient Registry Study included peripheral embolism and pulmonary embolism, and the ATRIA study included systemic embolism. Eight studies used ICD‐9 or ICD‐10 hospital discharge codes to identify outcome events 8, 15, 16, 17, 18, 19, 20, 21, 25. Seven of these did not specify whether nonprimary discharge diagnoses were also included; presumably they were 8, 15, 17, 18, 19, 20, 21, 25.…”

Section: Resultsmentioning

confidence: 99%

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Methodologic Differences Across Studies of Patients With Atrial Fibrillation Lead to Varying Estimates of Stroke Risk

Quinn

Severdija

Chang

et al. 2018

JAHA

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BackgroundGuidelines for anticoagulation in atrial fibrillation (AF) assume that stroke risk scheme point scores correspond to fixed stroke rates. However, reported stroke rates vary widely across AF cohort studies, including studies from the same country. Reasons for this variation are unclear. This study compares methodologies used to assemble and analyze large AF cohorts worldwide and assesses potential bias in estimating stroke rates.Methods and ResultsFrom a previous systematic review of AF cohorts, we analyzed studies including at least 5000 patients. We assessed methods used to generate rates of ischemic stroke off anticoagulants, according to a structured inventory of database interrogation methods. Nine studies (497 578 total patients) met our criteria. Overall cohort stroke rates ranged from 0.45% to 7.03% per year. In bivariate study‐level analysis, multiple features were associated with higher stroke rates, including AF identified as inpatients versus outpatients (rate ratio 2.60, 95% confidence interval, 1.19, 5.68), and lack of clinical validation of outcome events (rate ratio 4.09, 95% confidence interval, 1.06, 15.70). European studies reported rates more than 4‐fold higher than North American studies. International Classification of Diseases (ICD) coding schemes for outcomes varied widely. Multiple high rate features coexisted in the same studies.ConclusionsAmong AF cohort studies, differences in the composition, method of assembly, determination of clinical features and outcomes, and analytic approach were strongly associated with reported stroke rates. Our study highlights the need for standardized and validated methodologies for AF cohort assembly and analysis to generate accurate stroke rates to better support anticoagulation guidelines for patients with AF.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Methodologic Differences Across Studies of Patients With Atrial Fibrillation Lead to Varying Estimates of Stroke Risk

Quinn

Severdija

Chang

et al. 2018

JAHA

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Atrial Fibrillation, Type 2 Diabetes, and Non–Vitamin K Antagonist Oral Anticoagulants

2017

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Diabetes and atrial fibrillation in hospitalized patients in the United States

Kumar

Echouffo‐Tcheugui

2021

Clinical Cardiology

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Background Data on the burden of atrial fibrillation (AF) associated with diabetes among hospitalized patients are scarce. We assessed the AF‐related hospitalizations trends in patients with diabetes, and compared AF outcomes in patients with diabetes to those without diabetes. Hypothesis AF‐related health outcomes differ between patient with diabetes and without diabetes. Methods Using the National Inpatient Sample (NIS) 2004–2014, we studied trends in AF hospitalization rate among diabetic patients, and compared in‐hospital case fatality rate, length of stay (LOS), cost and utilization of rhythm control therapies, and 30‐day readmission rate between patients with and without diabetes. Logistic or Cox regression models were used to assess the differences in AF outcomes by diabetes status. Results Over the study period, there were 4 325 522 AF‐related hospitalizations, of which 1 075 770 (24.9%) had a diagnosis of diabetes. There was a temporal increase in AF hospitalization rate among diabetic patients (10.4 to 14.4 per 1000 hospitalizations among patients with diabetes; +4.4% yearly change, p‐trend < .0001). Among AF patients, those with diabetes had a lower in‐hospital mortality (adjusted odds ratio [aOR]: 0.68; 95% CI: 0.65–0.72) and LOS (aOR: 0.95; 95% CI: 0.94–0.96), but no difference in costs (aOR: 0.95; 95% CI: 0.94–0.96) and a higher 30‐day rate of readmissions compared with no diabetes (aHR 1.05; 95% CI: 1.01–1.08), compared to individuals without diabetes. Conclusion AF and diabetes coexist among hospitalized patients, with rising trends over the last decade. Diabetes is associated with lower rates in‐hospital adverse AF outcomes, but a higher 30‐day readmission risk.

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Glycated hemoglobin and risk of first episode stroke in diabetic patients with atrial fibrillation: A cohort study

Cited by 43 publications

References 27 publications

Methodologic Differences Across Studies of Patients With Atrial Fibrillation Lead to Varying Estimates of Stroke Risk

Methodologic Differences Across Studies of Patients With Atrial Fibrillation Lead to Varying Estimates of Stroke Risk

Atrial Fibrillation, Type 2 Diabetes, and Non–Vitamin K Antagonist Oral Anticoagulants

Diabetes and atrial fibrillation in hospitalized patients in the United States

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