Risk for Stroke After Newly Diagnosed Atrial Fibrillation During Hospitalization for Other Primary Diagnoses : A Retrospective Cohort Study.

IF 19.6 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Annals of Internal Medicine Pub Date : 2025-06-01 Epub Date: 2025-04-22 DOI:10.7326/ANNALS-24-01967
Husam Abdel-Qadir, Madison Gunn, Jiming Fang, Tomi Odugbemi, Irene Jeong, Peter C Austin, Paul Dorian, Cynthia A Jackevicius, Douglas S Lee, Sheldon M Singh, Karen Tu, Dennis T Ko
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引用次数: 0

Abstract

Background: Atrial fibrillation (AF) that is first diagnosed during hospitalization for other causes can subside with resolution of the inciting stressor.

Objective: To describe the risk for stroke after newly diagnosed AF during hospitalization for other causes.

Design: Population-based retrospective cohort study.

Setting: Ontario, Canada.

Participants: Patients aged 66 years or older discharged alive from the hospital between April 2013 and March 2023 with a first diagnosis of AF.

Intervention: Newly diagnosed AF during hospitalization for other causes, categorized into cardiac medical, noncardiac medical, cardiac surgical, and noncardiac surgical.

Measurements: The primary outcome was hospitalization for stroke. The cumulative incidence function was used to estimate crude incidence, censoring on anticoagulant dispensation. Inverse probability of censoring weights were used to account for informative censoring.

Results: Atrial fibrillation was diagnosed in 20 639 patients (mean age, 77.1 years; 58.1% male) while hospitalized for other causes: 8340 (40.4%) for noncardiac medical, 7097 (34.4%) for cardiac surgical, 3553 (17.2%) for noncardiac surgical, and 1649 (8.0%) for cardiac medical diagnoses. At 1 year, anticoagulants were being dispensed to 26.4% of patients with CHA2DS2-VA scores of 1 to 4 and 35.2% of those with CHA2DS2-VA scores of 5 to 8. The 1-year risk for stroke without anticoagulation was 1.3% (95% CI, 0.7% to 2.3%) for cardiac medical, 1.2% (CI, 0.9% to 1.5%) for noncardiac medical, 1.1% (CI, 0.8% to 1.7%) for noncardiac surgical, and 1.0% (CI, 0.7% to 1.3%) for cardiac surgical patients. Patients with CHA2DS2-VA scores of 1 to 4 had a 1-year stroke risk of 0.7% (CI, 0.6% to 1.0%) without anticoagulation, compared with 1.8% (CI, 1.4% to 2.2%) at CHA2DS2-VA scores of 5 to 8.

Limitation: Long-standing AF may have been misclassified as newly diagnosed, leading to overestimation of stroke risk.

Conclusion: Among patients with newly diagnosed AF during hospitalization for other causes, a substantial proportion with low CHA2DS2-VA scores receive anticoagulation, with modest increases in this proportion at higher scores. The stroke risk in patients with CHA2DS2-VA scores greater than 4 approximated the 2% threshold commonly used to initiate anticoagulation in AF.

Primary funding source: Canadian Cardiovascular Society.

住院期间新诊断房颤的卒中风险:一项回顾性队列研究
背景:因其他原因住院期间首次诊断的心房颤动(AF)可随着刺激应激源的消退而消退。目的:探讨因其他原因住院期间新诊断的房颤发生卒中的风险。设计:基于人群的回顾性队列研究。环境:加拿大安大略省。研究对象:2013年4月至2023年3月期间首次诊断为房颤的66岁及以上患者。干预措施:住院期间因其他原因新诊断为房颤,分为心脏内科、非心脏内科、心脏外科和非心脏外科。测量:主要终点是因中风住院。使用累积发生率函数估计粗发生率,并对抗凝剂分配进行审查。采用逆概率的审查权来说明信息审查。结果:房颤患者20639例(平均年龄77.1岁;58.1%男性),同时因其他原因住院:非心脏内科诊断8340人(40.4%),心脏外科诊断7097人(34.4%),非心脏外科诊断3553人(17.2%),心脏内科诊断1649人(8.0%)。1年时,26.4%的CHA2DS2-VA评分为1至4分的患者和35.2%的CHA2DS2-VA评分为5至8分的患者配用了抗凝剂。无抗凝治疗的心脏内科患者1年卒中风险为1.3% (95% CI, 0.7% ~ 2.3%),非心脏内科患者为1.2% (CI, 0.9% ~ 1.5%),非心脏外科患者为1.1% (CI, 0.8% ~ 1.7%),心脏外科患者为1.0% (CI, 0.7% ~ 1.3%)。CHA2DS2-VA评分为1至4分的患者,不抗凝治疗的1年卒中风险为0.7% (CI, 0.6%至1.0%),而CHA2DS2-VA评分为5至8分的患者1年卒中风险为1.8% (CI, 1.4%至2.2%)。局限性:长期房颤可能被误诊为新诊断,导致卒中风险高估。结论:在其他原因住院期间新诊断的房颤患者中,相当一部分CHA2DS2-VA评分较低的患者接受了抗凝治疗,较高评分的患者接受抗凝治疗的比例略有增加。CHA2DS2-VA评分大于4的患者卒中风险接近于房颤启动抗凝治疗常用的2%阈值。主要资金来源:加拿大心血管学会。
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
Annals of Internal Medicine
Annals of Internal Medicine 医学-医学:内科
CiteScore
23.90
自引率
1.80%
发文量
1136
审稿时长
3-8 weeks
期刊介绍: Established in 1927 by the American College of Physicians (ACP), Annals of Internal Medicine is the premier internal medicine journal. Annals of Internal Medicine’s mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. To achieve this mission, the journal publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to clinical practice, health care delivery, public health, health care policy, medical education, ethics, and research methodology. In addition, the journal publishes personal narratives that convey the feeling and the art of medicine.
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