Atrial Fibrillation, Stroke Risk, and Warfarin Therapy Revisited A Population-Based Study
TLDR
AF is more common than present guidelines suggest and is close to that of hypertension in individuals aged ≥80 years, and because a majority of patients with AF with increased risk for stroke had not received anticoagulation therapy, there is a large potential for improvement.Abstract:
Background and Purpose— Atrial fibrillation (AF) is a major risk factor for ischemic stroke. This study aims to update the knowledge about AF and associated stroke risk and benefits of anticoagulation. Methods— We extracted data from the hospital, specialized outpatient, and primary healthcare and drug registries in a Swedish region with 1.56 million residents. We identified all individuals who had received an AF diagnosis during the previous 5 years; all stroke events during 2010; and patients with AF aged ≥50 years who had received warfarin during 2009. Results— AF had been diagnosed in 38 446 subjects who were alive at the beginning of 2010 (prevalence of 3.2% in the adult [≥20 years] population); ≈46% received warfarin therapy. In 2010, there were 4565 ischemic stroke events and 861 intracranial hemorrhages. AF had been diagnosed in 38% of ischemic events (≥50% among those aged ≥80 years) and in 23% of intracranial hemorrhages. An AF diagnosis was often lacking in hospital discharge records after stroke events. Warfarin therapy was associated with an odds ratio of 0.50 (confidence interval, 0.43–0.57) for ischemic stroke and, despite an increased risk of intracranial hemorrhage, an odds ratio of 0.57 (confidence interval, 0.50–0.64) for the overall risk for stroke. Conclusions— AF is more common than present guidelines suggest. The attributable risk of AF for ischemic stroke increases with age and is close to that of hypertension in individuals aged ≥80 years. Because a majority of patients with AF with increased risk for stroke had not received anticoagulation therapy, there is a large potential for improvement.read more
Citations
More filters
Journal ArticleDOI
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Paulus Kirchhof,Stefano Benussi,Dipak Kotecha,Anders Ahlsson,Dan Atar,Barbara Casadei,Manuel Castellá,Hans-Christoph Diener,Hein Heidbuchel,Jeroen M.L. Hendriks,Gerhard Hindricks,Antonis S. Manolis,Jonas Oldgren,Bogdan A. Popescu,Ulrich Schotten,Bart P. Van Putte,Panagiotis Vardas,Stefan Agewall,John Camm,Gonzalo Barón Esquivias,Werner Budts,Scipione Carerj,Filip Casselman,Antonio Coca,Raffaele De Caterina,Spiridon Deftereos,Dobromir Dobrev,José M. Ferro,Gerasimos Filippatos,Donna Fitzsimons,Bulent Gorenek,Maxine Guenoun,Stefan H. Hohnloser,Philippe Kolh,Gregory Y.H. Lip,Athanasios J. Manolis,John J.V. McMurray,Piotr Ponikowski,Raphael Rosenhek,Frank Ruschitzka,Irina Savelieva,Sanjay Sharma,Piotr Suwalski,Juan Tamargo,Clare J Taylor,Isabelle C. Van Gelder,Adriaan A. Voors,Stephan Windecker,José Luis Zamorano,Katja Zeppenfeld +49 more
TL;DR: The Task Force for the management of atrial fibrillation of the European Society of Cardiology has been endorsed by the European Stroke Organisation (ESO).
Journal ArticleDOI
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS: The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC). Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Endorsed by the European Stroke Organisation (ESO)
Journal ArticleDOI
Validation of clinical classification schemes for predicting stroke: results from the national registry of atrial fibrillation☆
Brian F. Gage,Amy D. Waterman,William D. Shannon,Michael Boechler,Michael W. Rich,Martha J. Radford +5 more
TL;DR: The 2 existing classification schemes and especially a new stroke risk index, CHADS, can quantify risk of stroke for patients who have AF and may aid in selection of antithrombotic therapy.
Journal ArticleDOI
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS: The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC)Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESCEndorsed by the European Stroke Organisation (ESO)
Paulus Kirchhof,Stefano Benussi,Dipak Kotecha,Anders Ahlsson,Dan Atar,Barbara Casadei,Manuel Castellá,Hans-Christoph Diener,Hein Heidbuchel,Jeroen M.L. Hendriks,Gerhard Hindricks,Antonis S. Manolis,Jonas Oldgren,Bogdan A. Popescu,Ulrich Schotten,Bart P. van Putte,Panagiotis Vardas +16 more
TL;DR: Authors/Task Force Members: Paulus Kirchhof* (Chairperson) (UK/Germany), Stefano Benussi* (Co-Chair person) (Switzerland), Dipak Kotecha (UK), Anders Ahlsson (Sweden), Dan Atar (Norway), Barbara Casadei (UK)
References
More filters
Journal ArticleDOI
Atrial fibrillation as an independent risk factor for stroke: the Framingham Study.
TL;DR: The data suggest that the elderly are particularly vulnerable to stroke when atrial fibrillation is present, and the effects of hypertension, coronary heart disease, and cardiac failure on the risk of stroke became progressively weaker with increasing age.
Journal ArticleDOI
Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study.
Alan S. Go,Elaine M. Hylek,Kathleen A. Phillips,Yuchiao Chang,Lori E. Henault,Joe V. Selby,Daniel E. Singer +6 more
TL;DR: It is confirmed that atrial fibrillation is common among older adults and provides a contemporary basis for estimates of prevalence in the United States.
Journal ArticleDOI
Guidelines for the management of atrial fibrillation The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC)
A. John Camm,Paulus Kirchhof,Irene Savelieva,Isabelle C. Van Gelder,Gerhard Hindricks,Ottavio Alfieri,Johan De Sutter,Andreas Goette,Stefan H. Hohloser,Piotr Ponikowski,Frans H. Rutten +10 more
TL;DR: Estimates of expected health outcomes for larger societies are included, where data exist, and the level of evidence and the strength of recommendation of particular treatment options are weighed and graded according to pre-defined scales.
Journal ArticleDOI
Validation of Clinical Classification Schemes for Predicting Stroke: Results From the National Registry of Atrial Fibrillation
Brian F. Gage,Amy D. Waterman,William D. Shannon,Michael Boechler,Michael W. Rich,Martha J. Radford +5 more
TL;DR: The 2 existing classification schemes and especially a new stroke risk index, CHADS, can quantify risk of stroke for patients who have AF and may aid in selection of antithrombotic therapy.
Journal ArticleDOI
2012 focused update of the ESC Guidelines for the management of atrial fibrillation: An update of the 2010 ESC Guidelines for the management of atrial fibrillation * Developed with the special contribution of the European Heart Rhythm Association
A. John Camm,Jeroen J. Bax,Robert Fagard,Christian Funck-Brentano,David Hasdai,Theresa McDonagh,Bogdan A. Popescu,Udo Sechtem,Stephan Windecker,Ottavio Alfieri,Annalisa Angelini,Andreas Goette,Robert Hatala,Philippe Kolh,Piotr Ponikowski,Frans H. Rutten,Isabelle C. Van Gelder +16 more
TL;DR: An update of the 2010 ESC Guidelines for the management of atrial fibrillation with the special contribution of the European Heart Rhythm Association is developed.
Related Papers (5)
Atrial fibrillation as an independent risk factor for stroke: the Framingham Study.
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Paulus Kirchhof,Stefano Benussi,Dipak Kotecha,Anders Ahlsson,Dan Atar,Barbara Casadei,Manuel Castellá,Hans-Christoph Diener,Hein Heidbuchel,Jeroen M.L. Hendriks,Gerhard Hindricks,Antonis S. Manolis,Jonas Oldgren,Bogdan A. Popescu,Ulrich Schotten,Bart P. Van Putte,Panagiotis Vardas,Stefan Agewall,John Camm,Gonzalo Barón Esquivias,Werner Budts,Scipione Carerj,Filip Casselman,Antonio Coca,Raffaele De Caterina,Spiridon Deftereos,Dobromir Dobrev,José M. Ferro,Gerasimos Filippatos,Donna Fitzsimons,Bulent Gorenek,Maxine Guenoun,Stefan H. Hohnloser,Philippe Kolh,Gregory Y.H. Lip,Athanasios J. Manolis,John J.V. McMurray,Piotr Ponikowski,Raphael Rosenhek,Frank Ruschitzka,Irina Savelieva,Sanjay Sharma,Piotr Suwalski,Juan Tamargo,Clare J Taylor,Isabelle C. Van Gelder,Adriaan A. Voors,Stephan Windecker,José Luis Zamorano,Katja Zeppenfeld +49 more