March 16, 2017EBioMedicineOpen Access

Clinical Features and Prognosis in Patients with Atrial Fibrillation and Prior Stroke: Comparing the Fushimi and Darlington AF Registries

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Why the study?

Are there differences in recurrent stroke and mortality risks between Japanese and UK atrial fibrillation patients with prior stroke?

Structured PICO

Are there differences in recurrent stroke and mortality risks between Japanese and UK atrial fibrillation patients with prior stroke?

Population

1,116 atrial fibrillation (AF) patients with previous stroke from the Fushimi AF registry (Japan; n=688) and the Darlington AF registry (UK; n=428).

Intervention

Japanese cohort (Fushimi registry)

Comparator

UK cohort (Darlington registry)

Outcome

Recurrent stroke and all-cause mortalityhard clinical

Japanese AF patients with prior stroke have a lower risk of recurrent stroke but higher all-cause mortality compared to a UK cohort, highlighting ethnic differences in secondary prevention outcomes.

Implication

Ethnic differences in AF stroke risk profiles may affect uniform risk stratification; leaves open need for ethnicity-specific outcome validation.

Abstract

BACKGROUND: Ethnic differences in clinical characteristics, stroke risk profiles and outcomes among atrial fibrillation (AF) patients may exist. We therefore compared AF patients with previous stroke from Japan and the United Kingdom (UK). METHODS: We compared clinical characteristics, stroke risk and outcomes among AF patients from the Fushimi AF registry who had experienced a previous stroke (Japan; n=688; 19.7%) and the Darlington AF registry (UK; n=428; 19.0%). RESULTS: -VASc score was lower in AF patients in Fushimi than those in Darlington (5.18 vs. 5.57; p<0.01), oral anticoagulation (OAC) was prescribed significantly more frequently in Fushimi (68.3%) than Darlington (61.7%) (p=0.02). Multivariate logistic regression analysis showed that Japanese ethnicity was associated with a significantly decreased risk of recurrent stroke (OR 0.59. 95% CI 0.36-0.97; p=0.04) but a significantly increased risk of all-cause mortality (OR 1.76, 95% CI 1.18-2.66; p<0.01) in AF patients with previous stroke. CONCLUSIONS: AF patients with previous stroke in the UK were at higher risk of recurrent stroke compared to Japanese patients, but OAC was utilised less frequently. There was a lower risk of recurrent stroke in the secondary prevention cohort from the Fushimi registry, but an increased risk of all-cause mortality.