Temporal Trends of Ischemic Stroke Risk in Patients With Incident Atrial Fibrillation Before Anticoagulation

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology Pub Date : 2025-03-01 DOI:10.1016/j.jacep.2024.10.029

Konsta Teppo MD, PhD , K.E. Juhani Airaksinen MD, PhD , Olli Halminen PhD , Jussi Jaakkola MD, PhD , Jari Haukka PhD , Elis Kouki MD , Alex Luojus MD , Jukka Putaala MD, PhD , Birgitta Salmela MD, PhD , Miika Linna PhD , Aapo L. Aro MD, PhD , Pirjo Mustonen MD, PhD , Juha Hartikainen MD, PhD , Gregory Y.H. Lip MD , Mika Lehto MD, PhD

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引用次数: 0

Abstract

Background

Atrial fibrillation (AF) is a major risk factor for ischemic stroke (IS), but whether the magnitude of this risk has changed over time is unknown.

Objectives

This study sought to investigate temporal trends in IS rates in patients with incident AF before oral anticoagulant agent (OAC) therapy.

Methods

The nationwide FinACAF (Finnish Anticoagulation in Atrial Fibrillation) study covers patients with AF at all levels of care in Finland from 2007 to 2018. A 4-week quarantine period from AF diagnosis was applied, and only follow-up time without OAC therapy was included. Incidence rates of IS were computed in 4-year intervals in relation to sex and non-sex CHA₂DS₂-VASc (ie, CHA₂DS₂-VA) score values.

Results

In total, 129,789 patients with new-onset AF were identified (49.2% women; mean age: 71.4 ± 14.5 years). Between the calendar year intervals of 2007-2010 and 2015-2018, the patients’ mean CHA₂DS₂-VA score increased from 2.5 to 3.0, and concurrently the overall IS rate decreased by 25% from 36.7 to 27.6 events per 1,000 patient-years. This trend was driven by a 32% decrease of IS rate in women, particularly among those with higher age and CHA₂DS₂-VA scores. The IS rate in patients with a CHA₂DS₂-VA score of 1 was 8.2 events per 1,000 patient-years and remained stable across the study period.

Conclusions

The initial IS risk in AF patients, before the initiation of OAC therapy, has decreased by 25% between 2007 and 2018 despite an increase in both age and stroke risk scores. The decrease has been most pronounced in older women with high stroke risk scores.

查看原文本刊更多论文

抗凝前房颤患者缺血性卒中风险的时间趋势。

背景：房颤（AF）是缺血性卒中（is）的主要危险因素，但这种危险的程度是否随时间而改变尚不清楚。目的：本研究旨在探讨口服抗凝剂（OAC）治疗前AF患者IS发生率的时间趋势。方法：芬兰全国范围内的FinACAF（芬兰房颤抗凝）研究涵盖了2007年至2018年芬兰各级护理的房颤患者。房颤诊断后的4周隔离期，仅包括未接受OAC治疗的随访时间。IS的发病率与性别和非性别CHA2DS2-VASc（即CHA2DS2-VA）评分值相关，每隔4年计算一次。结果：共发现129789例新发房颤患者(49.2%为女性；平均年龄：71.4±14.5岁)。在2007-2010年至2015-2018年的历年间隔期间，患者的平均CHA2DS2-VA评分从2.5上升到3.0，同时总体IS发生率从每1000患者年36.7次下降到27.6次，下降了25%。这一趋势是由于女性的IS发病率下降了32%，特别是在年龄和CHA2DS2-VA评分较高的女性中。CHA2DS2-VA评分为1的患者的IS发生率为每1000患者年8.2例事件，并在整个研究期间保持稳定。结论：在开始OAC治疗之前，房颤患者的初始IS风险在2007年至2018年间下降了25%，尽管年龄和卒中风险评分均有所增加。这种下降在中风风险评分较高的老年妇女中最为明显。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

5.70%

发文量

250

期刊介绍： JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.