No decline in the risk of stroke following incident atrial fibrillation since 2000 in the community: A concerning trend

Alanna Chamberlain, Robert D Jr. Brown, Alvaro Alonso, Bernard J. Gersh, Jill M. Killian, Susan A. Weston, Veronique Lee Roger

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background-While atrial fibrillation is a recognized risk factor for stroke, contemporary data on trends in stroke incidence after the diagnosis of atrial fibrillation are scarce. Methods and Results-Olmsted County, MN residents with incident atrial fibrillation or atrial flutter (collectively referred to as AF) from 2000 to 2010 were identified. Cox regression determined associations of year of AF diagnosis with ischemic stroke and transient ischemic attack (TIA) occurring through 2013. Among 3247 AF patients, 321 (10%) had an ischemic stroke/TIA over a mean of 4.6 years (incidence rate [95% CI] per 100 person-years: 2.14 [1.91-2.38]). Two hundred thirty-nine (7%) of 3265 AF patients experienced an ischemic stroke (incidence rate: 1.54 [1.35-1.75]). The risk of both outcomes remained unchanged over time after adjusting for demographics and comorbidities (hazard ratio [95% CI] per year of AF diagnosis: 1.00 [0.96-1.04] for ischemic stroke/TIA; 1.01 [0.96-1.06] for ischemic stroke only). In analyses restricted to patients with prescription information, the rates of anticoagulation use did not change over time, reaching 50.8% at 1 year after AF diagnosis. Further adjustment for anticoagulation use did not alter the temporal trends in stroke incidence (hazard ratio [95% CI] per year of AF diagnosis: 1.06 [0.97-1.15] for ischemic stroke/TIA; 1.08 [0.98-1.20] for ischemic stroke only). Conclusions-Strokes/TIAs are frequent after AF, occurring in 10% of patients after 5 years of follow-up. The occurrence of stroke/TIA did not decline over the last decade, which may be influenced by a leveling offof anticoagulation use. This concerning trend has major public health implications.

Original languageEnglish (US)
Article numbere003408
JournalJournal of the American Heart Association
Volume5
Issue number6
DOIs
StatePublished - Jun 1 2016

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Atrial Fibrillation
Stroke
Transient Ischemic Attack
Incidence
Atrial Flutter
Prescriptions
Comorbidity
Public Health
Demography

Keywords

  • Atrial fibrillation
  • Ischemic stroke
  • Temporal trends
  • Transient ischemic attack

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

No decline in the risk of stroke following incident atrial fibrillation since 2000 in the community : A concerning trend. / Chamberlain, Alanna; Brown, Robert D Jr.; Alonso, Alvaro; Gersh, Bernard J.; Killian, Jill M.; Weston, Susan A.; Roger, Veronique Lee.

In: Journal of the American Heart Association, Vol. 5, No. 6, e003408, 01.06.2016.

Research output: Contribution to journalArticle

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title = "No decline in the risk of stroke following incident atrial fibrillation since 2000 in the community: A concerning trend",
abstract = "Background-While atrial fibrillation is a recognized risk factor for stroke, contemporary data on trends in stroke incidence after the diagnosis of atrial fibrillation are scarce. Methods and Results-Olmsted County, MN residents with incident atrial fibrillation or atrial flutter (collectively referred to as AF) from 2000 to 2010 were identified. Cox regression determined associations of year of AF diagnosis with ischemic stroke and transient ischemic attack (TIA) occurring through 2013. Among 3247 AF patients, 321 (10{\%}) had an ischemic stroke/TIA over a mean of 4.6 years (incidence rate [95{\%} CI] per 100 person-years: 2.14 [1.91-2.38]). Two hundred thirty-nine (7{\%}) of 3265 AF patients experienced an ischemic stroke (incidence rate: 1.54 [1.35-1.75]). The risk of both outcomes remained unchanged over time after adjusting for demographics and comorbidities (hazard ratio [95{\%} CI] per year of AF diagnosis: 1.00 [0.96-1.04] for ischemic stroke/TIA; 1.01 [0.96-1.06] for ischemic stroke only). In analyses restricted to patients with prescription information, the rates of anticoagulation use did not change over time, reaching 50.8{\%} at 1 year after AF diagnosis. Further adjustment for anticoagulation use did not alter the temporal trends in stroke incidence (hazard ratio [95{\%} CI] per year of AF diagnosis: 1.06 [0.97-1.15] for ischemic stroke/TIA; 1.08 [0.98-1.20] for ischemic stroke only). Conclusions-Strokes/TIAs are frequent after AF, occurring in 10{\%} of patients after 5 years of follow-up. The occurrence of stroke/TIA did not decline over the last decade, which may be influenced by a leveling offof anticoagulation use. This concerning trend has major public health implications.",
keywords = "Atrial fibrillation, Ischemic stroke, Temporal trends, Transient ischemic attack",
author = "Alanna Chamberlain and Brown, {Robert D Jr.} and Alvaro Alonso and Gersh, {Bernard J.} and Killian, {Jill M.} and Weston, {Susan A.} and Roger, {Veronique Lee}",
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T1 - No decline in the risk of stroke following incident atrial fibrillation since 2000 in the community

T2 - A concerning trend

AU - Chamberlain, Alanna

AU - Brown, Robert D Jr.

AU - Alonso, Alvaro

AU - Gersh, Bernard J.

AU - Killian, Jill M.

AU - Weston, Susan A.

AU - Roger, Veronique Lee

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N2 - Background-While atrial fibrillation is a recognized risk factor for stroke, contemporary data on trends in stroke incidence after the diagnosis of atrial fibrillation are scarce. Methods and Results-Olmsted County, MN residents with incident atrial fibrillation or atrial flutter (collectively referred to as AF) from 2000 to 2010 were identified. Cox regression determined associations of year of AF diagnosis with ischemic stroke and transient ischemic attack (TIA) occurring through 2013. Among 3247 AF patients, 321 (10%) had an ischemic stroke/TIA over a mean of 4.6 years (incidence rate [95% CI] per 100 person-years: 2.14 [1.91-2.38]). Two hundred thirty-nine (7%) of 3265 AF patients experienced an ischemic stroke (incidence rate: 1.54 [1.35-1.75]). The risk of both outcomes remained unchanged over time after adjusting for demographics and comorbidities (hazard ratio [95% CI] per year of AF diagnosis: 1.00 [0.96-1.04] for ischemic stroke/TIA; 1.01 [0.96-1.06] for ischemic stroke only). In analyses restricted to patients with prescription information, the rates of anticoagulation use did not change over time, reaching 50.8% at 1 year after AF diagnosis. Further adjustment for anticoagulation use did not alter the temporal trends in stroke incidence (hazard ratio [95% CI] per year of AF diagnosis: 1.06 [0.97-1.15] for ischemic stroke/TIA; 1.08 [0.98-1.20] for ischemic stroke only). Conclusions-Strokes/TIAs are frequent after AF, occurring in 10% of patients after 5 years of follow-up. The occurrence of stroke/TIA did not decline over the last decade, which may be influenced by a leveling offof anticoagulation use. This concerning trend has major public health implications.

AB - Background-While atrial fibrillation is a recognized risk factor for stroke, contemporary data on trends in stroke incidence after the diagnosis of atrial fibrillation are scarce. Methods and Results-Olmsted County, MN residents with incident atrial fibrillation or atrial flutter (collectively referred to as AF) from 2000 to 2010 were identified. Cox regression determined associations of year of AF diagnosis with ischemic stroke and transient ischemic attack (TIA) occurring through 2013. Among 3247 AF patients, 321 (10%) had an ischemic stroke/TIA over a mean of 4.6 years (incidence rate [95% CI] per 100 person-years: 2.14 [1.91-2.38]). Two hundred thirty-nine (7%) of 3265 AF patients experienced an ischemic stroke (incidence rate: 1.54 [1.35-1.75]). The risk of both outcomes remained unchanged over time after adjusting for demographics and comorbidities (hazard ratio [95% CI] per year of AF diagnosis: 1.00 [0.96-1.04] for ischemic stroke/TIA; 1.01 [0.96-1.06] for ischemic stroke only). In analyses restricted to patients with prescription information, the rates of anticoagulation use did not change over time, reaching 50.8% at 1 year after AF diagnosis. Further adjustment for anticoagulation use did not alter the temporal trends in stroke incidence (hazard ratio [95% CI] per year of AF diagnosis: 1.06 [0.97-1.15] for ischemic stroke/TIA; 1.08 [0.98-1.20] for ischemic stroke only). Conclusions-Strokes/TIAs are frequent after AF, occurring in 10% of patients after 5 years of follow-up. The occurrence of stroke/TIA did not decline over the last decade, which may be influenced by a leveling offof anticoagulation use. This concerning trend has major public health implications.

KW - Atrial fibrillation

KW - Ischemic stroke

KW - Temporal trends

KW - Transient ischemic attack

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