Stroke Severity in Atrial Fibrillation

Lin, Hongbo; Wolf, Philip A.; Kelly-Hayes, Margaret; Beiser, Alexa; Kase, Carlos S.; Benjamin, Emelia J.; D’Agostino, Ralph B.

doi:10.1161/01.str.27.10.1760

Cited by 1,224 publications

(784 citation statements)

References 19 publications

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“…Pre-existing congestive heart failure [32][33][34] and atrial arrhythmia 32,33,[35][36][37] are well-documented risk factors for mortality after stroke, and our findings suggest a prognostic significance of these conditions in thrombolysis patients. However, in our study, the increased risk of mortality attributable to these conditions is very similar in thrombolysis and nonthrombolysis patients, suggesting that these conditions should probably not be considered contraindications to thrombolysis.…”

Section: Bateman Et Al Thrombolysis Nationwide Inpatient Samplesupporting

confidence: 54%

Factors Associated With In-Hospital Mortality After Administration of Thrombolysis in Acute Ischemic Stroke Patients

Bateman

Schumacher

Boden‐Albala

et al. 2006

Stroke

111

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Background and Purpose-The prospective trials evaluating the safety and efficacy of intravenous tissue plasminogen activator have generally been conducted at academic medical centers and community hospitals with an institutional commitment to stroke care. Relatively little is known about the safety of this therapy as it is used in the community. We therefore examined outcomes in acute stroke patients treated with thrombolysis using the largest discharge database available in the United States for the years 1999 to 2002. Methods-Data were derived from the Nationwide Inpatient Sample for the years 1999 to 2002. Using the appropriateInternational Classification of Disease-Clinical Modification, 9th revision, codes, patients admitted through the emergency room with a primary diagnosis of acute ischemic stroke were selected for analysis. From these patients, those coded as receiving thrombolysis were identified. Multivariate logistic regression was performed on the thrombolysis and nonthrombolysis cohorts to identify independent predictors of in-hospital mortality from among those clinical elements available in the database. Results-We identified 2594 patients treated with thrombolysis from a group of 248 964 patients admitted through the emergency room with a primary diagnosis of acute ischemic stroke. The thrombolysis cohort had a higher in-hospital mortality rate compared with the nonthrombolysis patients (11.4% versus 6.8%). The rate of intracerebral hemorrhage was 4.4% for the thrombolysis cohort and 0.4% for nonthrombolysis patients. Multivariate logistic regression showed advanced age, Asian/Pacific Islander race, congestive heart failure, and atrial fibrillation/flutter to be independent predictors of in-hospital mortality after thrombolysis. Thrombolysis volume, overall ischemic stroke volume, and teaching status were not significant predictors of in-hospital mortality after thrombolysis. Conclusions-Thrombolysis, as it is used in the community, has a safety profile that is similar to that observed in the large, prospective clinical trials. (Stroke. 2006;37:440-446.)

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Section: Bateman Et Al Thrombolysis Nationwide Inpatient Samplesupporting

confidence: 54%

Factors Associated With In-Hospital Mortality After Administration of Thrombolysis in Acute Ischemic Stroke Patients

Bateman

Schumacher

Boden‐Albala

et al. 2006

Stroke

111

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“…In people aged 80-89 years, approximately 25% of all strokes are due to AF (1). Strokes associated with AF are more likely to be severe and have a higher initial mortality than non-AF strokes (3,4). In the context of demographic changes, the number of people suffering from AF will increase in the future.…”

Section: Introductionmentioning

confidence: 99%

Incidence, prevalence and 1-year all-cause mortality of heart failure in Germany: a study based on electronic healthcare data of more than six million persons

et al. 2015

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CitationIncidence, prevalence and 1-year all-cause mortality of heart failure in Germany: a study based on electronic healthcare data of more than six million persons. Abstract AimsData on the epidemiology of atrial fibrillation (AF) and its antithrombotic management in elderly populations are scarce. The aims of this study were to estimate the incidence and prevalence of AF in the elderly in Germany and to describe antithrombotic management of AF cases. MethodsEstimation of prevalence and incidence was based on data of three German statutory health insurances, which insured more than 800,000 people aged 65 years and older in the study Treatment was less common among women and older people. ConclusionIncidence and prevalence of AF are relatively high in the elderly in Germany. A considerable fraction of new AF cases did not receive antithrombotic drugs in routine care.

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“…Patients with AF‐related strokes have worse prognosis and higher risk of recurrent events compared with non‐AF‐related strokes 4. Prevention of stroke and systemic embolism is facilitated through the use of antithrombotic agents, principally oral vitamin K‐antagonists or direct OACs (oral anticoagulants) 5, 6, 7, 8.…”

mentioning

confidence: 99%

Stroke Risk and Treatment in Patients with Atrial Fibrillation and Low CHA ₂ DS ₂ ‐VASc Scores: Findings From the ORBIT‐AF I and II Registries

Jackson

Kim

Fonarow

et al. 2018

JAHA

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BackgroundCurrent American College of Cardiology/American Heart Association guidelines suggest that for patients with atrial fibrillation who are at low risk for stroke (CHA2DS2VASc=1) (or women with CHA2DS2VASc=2) a variety of treatment strategies may be considered. However, in clinical practice, patterns of treatment in these “low‐risk” patients are not well described. The objective of this analysis is to define thromboembolic event rates and to describe treatment patterns in patients with low‐risk CHA2DS2VASc scores.Methods and ResultsWe compared characteristics, treatment strategies, and outcomes among patients with a CHA2DS2VASc=0, CHA2DS2VASc=1, females with a CHA2DS2VASc=2, and CHA2DS2VASc ≥2 in ORBIT‐AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) I & II. Compared with CHA2DS2VASc ≥2 patients (84.2%), those with a CHA2DS2VASc=0 (60.3%), 1 (69.9%), and females with a CHA2DS2VASc score=2 (72.4%) were significantly less often treated with oral anticoagulation (P<0.0001). Stroke rates were low overall and ranged from 0 per 100 patient‐years in those with CHA2DS2VASc=0, 0.8 (95% confidence interval [CI] [0.5–1.2]) in those with CHA2DS2VASc=1, 0.8 (95% CI [0.4–1.6]) in females with a CHA2DS2VASc score=2, and 1.7 (95% CI [1.6–1.9]) in CHA2DS2VASc ≥2. All‐cause mortality (per 100 patient‐years) was highest in females with a CHA2DS2VASc score=2 (1.4) (95% CI [0.8–2.3]), compared with patients with a CHA2DS2VASc=0 (0.2) (95% CI [0.1–1.0]), and CHA2DS2VASc=1 (1.0) (95% CI [0.7–1.4]), but lower than patients with a CHA2DS2VASc ≥2 (5.7) (95% CI [5.4–6.0]).ConclusionThe majority of CHA2DS2VASc=0‐1 patients are treated with oral anticoagulation. In addition, the absolute risks of death and stroke/transient ischemic attack were low among both male and females CHA2DS2VASc=0‐1 as well as among females with a CHA2DS2VASc score=2.Clinical Trial RegistrationURL:http://www.clinicaltrials.gov. Unique identifier: NCT01701817.

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Stroke Severity in Atrial Fibrillation

Cited by 1,224 publications

References 19 publications

Factors Associated With In-Hospital Mortality After Administration of Thrombolysis in Acute Ischemic Stroke Patients

Factors Associated With In-Hospital Mortality After Administration of Thrombolysis in Acute Ischemic Stroke Patients

Incidence, prevalence and 1-year all-cause mortality of heart failure in Germany: a study based on electronic healthcare data of more than six million persons

Stroke Risk and Treatment in Patients with Atrial Fibrillation and Low CHA ₂ DS ₂ ‐VASc Scores: Findings From the ORBIT‐AF I and II Registries

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Stroke Severity in Atrial Fibrillation

Cited by 1,224 publications

References 19 publications

Factors Associated With In-Hospital Mortality After Administration of Thrombolysis in Acute Ischemic Stroke Patients

Factors Associated With In-Hospital Mortality After Administration of Thrombolysis in Acute Ischemic Stroke Patients

Incidence, prevalence and 1-year all-cause mortality of heart failure in Germany: a study based on electronic healthcare data of more than six million persons

Stroke Risk and Treatment in Patients with Atrial Fibrillation and Low CHA 2 DS 2 ‐VASc Scores: Findings From the ORBIT‐AF I and II Registries

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Stroke Risk and Treatment in Patients with Atrial Fibrillation and Low CHA ₂ DS ₂ ‐VASc Scores: Findings From the ORBIT‐AF I and II Registries