Trend in Mortality after Stroke with Atrial Fibrillation

Frost, Lars; Andersen, Ljubica Vukelic; Vestergaard, Peter; Husted, Steen; Mortensen, Leif Spange

doi:10.1016/j.amjmed.2005.12.027

Cited by 83 publications

(61 citation statements)

References 22 publications

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“…These registries have previously been validated, 13,14,16 and the predictive value of the diagnosis of AF was found to be high (99%), with a sensitivity of 88% and a specificity of 88% to 99% in these registries. 17 Comparable statistics has been found for ischemic stroke.…”

Section: Registry Data Sourcesmentioning

confidence: 84%

Age Dependence of Risk Factors for Stroke and Death in Young Patients With Atrial Fibrillation

Melgaard

Rasmussen

Skjøth

et al. 2014

Stroke

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8 the CHADS 2 score has been refined by use of the CHA 2 DS 2 -VASc (congestive heart failure, hypertension, age ≥75 years [doubled], diabetes, stroke/transient cerebral ischemia/thromboembolism [doubled], vascular disease [previous myocardial infarction, peripheral artery disease, or aortic plaque], age 65-74 years, sex category [female]) score. 9 The CHA 2 DS 2 -VASc score includes additional common stroke risk factors. [10][11][12] The CHA 2 DS 2 -VASc score better identifies the truly low-risk patients with AF who do not require any antithrombotic therapy, so that those with ≥1 stroke risk factors can be offered effective antithrombotic treatment. 9Risk stratification scores for AF have primarily been evaluated in patients with AF with a mean age >65 years. No study has adequately investigated whether risk factors of the CHA 2 DS 2 -VASc score have similar impact among younger patients with AF, and secondly, whether the increasing number of CHA 2 DS 2 -VASc risk factors is associated with comparable increases in stroke risk in all age groups. We hypothesize that the CHA 2 DS 2 -VASc Background and Purpose-The risk of stroke and death in patients with atrial fibrillation is strongly associated with age and concomitant comorbidities. The aim of this study was to examine the age dependence of risk factors for stroke and mortality in young patients with atrial fibrillation. Methods-This study is a population-based cohort study of 30-to 65-year-old patients with atrial fibrillation and diagnosed during 2000 to 2011, identified by record linkage between nationwide Danish registries. Cox regression models were used to estimate the risk of stroke and mortality according to risk factors within age groups: 30 to 50, 50 to 65, and 65 to 75 years. Results-We identified 73 799 nonvalvular atrial fibrillation patients, of which 37 782 (51.2%) were <65 years old (mean age 62.8). A higher modified cardiac failure or dysfunction, hypertension, age 75 (doubled), diabetes, stroke (doubled), vascular disease, age 65-74 and sex category (female) score (CHA 2 DS 2 -VASc score) was associated with decreased survival probability in all age groups. The overall incidence of stroke per year for 1 year (5 years) follow-up was 1.2% (0.6%), 3.5% (1.6%), and 5.6% (2.8%), respectively, for the age groups of 30 to 50, 50 to 65, and 65 to 75. Overall, risk factors such as previous stroke, heart failure, vascular disease, diabetes mellitus, and hypertension remained independent predictors of stroke and death in patients <65 years old with nonvalvular atrial fibrillation. Conclusions-The CHA 2 DS 2 -VASc score is an applicable tool for all age groups and in nonvalvular atrial fibrillation patients <65 years old, the same risk factors apply. (Stroke. 2014;45:1331-1337.)

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Section: Registry Data Sourcesmentioning

confidence: 84%

Age Dependence of Risk Factors for Stroke and Death in Young Patients With Atrial Fibrillation

Melgaard

Rasmussen

Skjøth

et al. 2014

Stroke

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“…20 The positive predictive value of the diagnosis of atrial fibrillation is as high as 99% in the registry. 21 Ischemic stroke also had a positive predictive value of 87.6% in the Danish registry, 9 and data on prescription claims are very accurate. 22 The results from the present study are similar to and broadly comparable with the results from the Non-Rheumatic Atrial Fibrillation registry (NRAF), which was initially used to validate the CHADS 2 score.…”

Section: Discussionmentioning

confidence: 99%

Added Predictive Ability of the CHA ₂ DS ₂ VASc Risk Score for Stroke and Death in Patients With Atrial Fibrillation

Larsen

Lip

Skjøth

et al. 2012

Circ: Cardiovascular Quality and Outcomes

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Background— The objective of this study was to evaluate the added predictive ability of the CHA 2 DS 2 VASc prediction rule for stroke and death in a nonanticoagulated population of patients with atrial fibrillation. Methods and Results— We included 1603 nonanticoagulated patients with incident atrial fibrillation from a Danish prospective cohort study of 57 053 middle-aged men and women. The Net Reclassification Improvement was calculated as a measure to estimate any overall improvement in reclassification with the CHA 2 DS 2 VASc sore as an alternative to the CHADS 2 score. After 1-year follow-up, crude incidence rates were 3.4 per 100 person-years for stroke and 13.6 for death. After a mean follow-up of 5.4 years (±3.7 years), the crude incidence rates for stroke and death were 1.9 and 5.6, respectively. During the entire observation period, the c-statistics and negative predictive values were similar for both risk scores. The Net Reclassification Improvement analysis showed that 1 of 10 reclassified atrial fibrillation patients would have been upgraded correctly using the CHA 2 DS 2 VASc score. Conclusions— Both the CHADS 2 as well as the CHA 2 DS 2 VASc risk score can exclude a large proportion of patients from having high risk of stroke or death. However, using the CHA 2 DS 2 VASc risk score, fewer patients will fulfill the criterion for low risk (and are truly low risk for thromboembolism). For every 10 extra patients transferred to the treatment group at 5 years, using the CHA 2 DS 2 VASc risk score, 1 patient would have had a stroke that might have been avoided with effective treatment.

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“…8,10 Survival rates after stroke associated with AF are increasing, but the subsequent disability and morbidity remain a major concern and reason for systematic follow-up in post-PVI patients. 26 Evidence is insufficient and conflicting as to the effect of oral anticoagulant therapy on risk reduction of stroke in post-PVI care, but current guidelines recommend continued oral anticoagulant be CHADS 2 (risk score of congestive heart failure, hypertension, age >75 years, diabetes, prior stroke or transient ischemic attack) guided.…”

Section: Discussionmentioning

confidence: 99%

Atrial Ectopy Predicts Late Recurrence of Atrial Fibrillation After Pulmonary Vein Isolation

Gang

Nalliah

Lim

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Background-Late recurrence of atrial fibrillation (AF) after radiofrequency ablation remains significant. Asymptomatic recurrence poses a difficult clinical problem as it is associated with an equally increased risk of stroke and death compared with symptomatic AF events. Meta-analyses reveal that no single preablation patient characteristic efficiently predicts these AF recurrences. This study aimed to evaluate the prognostic value of premature atrial complex (PAC) occurrence with regard to the risk of late AF recurrence after radiofrequency ablation. Methods and Results-The study cohort consisted of 124 patients with 7-day Holter recordings at 6 months post radiofrequency ablation for AF. No patients had AF recurrence before this time. Patients were followed-up every 6 months. Holter-detected PACs were defined as any supraventricular complexes occurring >30% earlier than expected.

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Trend in Mortality after Stroke with Atrial Fibrillation

Cited by 83 publications

References 22 publications

Age Dependence of Risk Factors for Stroke and Death in Young Patients With Atrial Fibrillation

Age Dependence of Risk Factors for Stroke and Death in Young Patients With Atrial Fibrillation

Added Predictive Ability of the CHA ₂ DS ₂ VASc Risk Score for Stroke and Death in Patients With Atrial Fibrillation

Atrial Ectopy Predicts Late Recurrence of Atrial Fibrillation After Pulmonary Vein Isolation

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Trend in Mortality after Stroke with Atrial Fibrillation

Cited by 83 publications

References 22 publications

Age Dependence of Risk Factors for Stroke and Death in Young Patients With Atrial Fibrillation

Age Dependence of Risk Factors for Stroke and Death in Young Patients With Atrial Fibrillation

Added Predictive Ability of the CHA 2 DS 2 VASc Risk Score for Stroke and Death in Patients With Atrial Fibrillation

Atrial Ectopy Predicts Late Recurrence of Atrial Fibrillation After Pulmonary Vein Isolation

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Added Predictive Ability of the CHA ₂ DS ₂ VASc Risk Score for Stroke and Death in Patients With Atrial Fibrillation