The impact of atrial fibrillation and long-term oral anticoagulant use on all-cause and cardiovascular mortality: A 12-year evaluation of the prospective Brazilian Study of Stroke Mortality and Morbidity

Abstract

Background: Atrial fibrillation (AF) is a predictor of poor prognosis after stroke. Aims: To evaluate AF and all-cause and cardiovascular (CVD) mortality in a stroke cohort with low socioeconomic status (SES), taking into consideration oral anticoagulant (OAC) use during 12-year follow-up. Methods: All-cause mortality was analyzed by Kaplan-Meier survival curve and Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (95%CI). For specific mortality causes, cumulative incidence functions were computed. A logit link function was used to calculate odds ratios (OR) with 95% CIs. Full models were adjusted by age, sex, OAC use (as a time-dependent variable) and cardiovascular risk factors. Results: Of 1,121 ischemic stroke (IS) participants, 17.8 % had AF. Overall, 654 deaths (58.3%) were observed. Survival rate was lower (median days, interquartile range-IQR) among those with AF (531, IQR: 46-2,039) vs. non-AF (1,808, IQR: 334-3,301), p-log rank <0.0001). Over 12-year follow-up, previous AF was associated with increased mortality: all-cause (multivariable HR, 1.82; 95%CI: 1.43-2.31) and CVD mortality (multivariable OR, 2.07; 95%CI: 1.36-3.14), but not stroke mortality. In the same multivariable models, OAC use was inversely associated with all-cause mortality (OAC time-dependent effect: multivariable HR, 0.47; 95%CI: 0.30-0.50, p=0.002) and stroke mortality (OAC time-dependent effect ≥ 6 months: multivariable OR, 0.09; 95% CI: 0.01-0.65, p-value=0.02), but not CVD mortality. Conclusions: Among individuals with low SES, AF was an independent predictor of poor survival, increasing all-cause and CVD mortality risk. Long-term OAC use was associated with a markedly reduced risk of all-cause and stroke mortality.

Estatística Cardiovascular – Brasil 2021

“…243 • Em uma coorte de 1.121 pacientes com AVC isquêmico em seguimento de 12 anos, FA foi independentemente associada a aumento da mortalidade geral (HR 1,82; 95% CI, 1,43-2,31) e cardiovascular (HR 2,07; 95% CI, 1, 14). 244…”

“…241 • Em uma coorte de 1.121 pacientes com AVC isquêmico, 200 dos quais com FA, anticoagulação para FA foi inversamente associada com mortalidade por todas as causas (efeito tempodependente de anticoagulante oral: HR multivariável, 0,47; 95% CI, 0,30-0,50) e mortalidade por AVC (efeito tempo-dependente de anticoagulante oral ≥ 6 meses: OR multivariável, 0,09; 95% CI, 0,01-0,65), mas não com mortalidade cardiovascular. 244 • A qualidade da terapia com varfarina foi avaliada usando TTR como parâmetro em diferentes amostras no Brasil. O TTR da anticoagulação para FA variou de 31% a 67% nos estudos.…”

“…• In a cohort of 1121 ischemic stroke patients in a 12-year follow-up, AF was independently associated with increased overall (HR 1.82; 95% CI, 1.43-2.31) and cardiovascular (HR 2.07; 95% CI, 1.36-3.14) mortality. 244 …”

“…• In a cohort of 1121 ischemic stroke patients, 200 of whom had AF, anticoagulation for AF was inversely associated with all-cause mortality (oral anticoagulant time-dependent effect: multivariable HR, 0.47; 95% CI, 0.30–0.50) and stroke mortality (oral anticoagulant time-dependent effect ≥ 6 months: multivariable OR, 0.09; 95% CI, 0.01–0.65), but not with cardiovascular mortality. 244 …”

Prevalence, risk factors, and prediction of inappropriate use of non-vitamin K antagonist oral anticoagulants in elderly Chinese patients with atrial fibrillation: A study protocol

“…It also leads to severe complications, such as impaired quality of life, heart failure, dementia, disability, and even death. More frequent hospitalization and treatment of these complications substantially increase the economic burden of the disease ( 2 – 5 ).…”