Time Trends of Ischemic Stroke Incidence and Mortality in Patients Diagnosed With First Atrial Fibrillation in 1980 to 2000
Why the study?
Has the incidence and survival of ischemic stroke after first atrial fibrillation diagnosis improved from 1980 to 2000?
Population
4,117 residents of Olmsted County, Minn, diagnosed with first atrial fibrillation from 1980 to 2000 and…
Design
Cohort
Follow-up
mean 5.5+/-5.0 years
Authors
Discussion
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Implication
Stroke incidence after AF declined with rising antithrombotic use; observational data leaves open mortality determinants for prospective study.
Key Points
- To determine whether the incidence and survival of ischemic stroke improved over time following a first diagnosis of atrial fibrillation.
- Retrospective population-based cohort study including residents of Olmsted County, Minnesota diagnosed with first atrial fibrillation between 1980 and 2000 (N=4,117 without prior stroke), followed through medical records to 2004 (mean follow-up 5.5 ± 5.0 years).
- Evaluated primary outcomes of first ischemic stroke and all-cause mortality alongside trends in systolic blood pressure and antithrombotic therapies (warfarin and aspirin).
- A first ischemic stroke occurred in 446 subjects (11%), with age- and sex-adjusted stroke incidence declining by an average of 3.4% per year (P=0.0001), coinciding with significant increases in warfarin and aspirin use (both P<0.0001) and reductions in systolic blood pressure (P<0.001).
- Age-adjusted stroke incidence was initially higher in women than men (P=0.039), but the difference was eliminated after adjusting for systolic blood pressure (P=0.41).
- Compared to the general regional population, the relative mortality hazard ratio was 1.88 for men and 1.84 for women without stroke, and 3.03 for men and 3.80 for women with stroke (P<0.05), with relative mortality risk showing no improvement over calendar time.
Structured PICO
Has the incidence and survival of ischemic stroke after first atrial fibrillation diagnosis improved from 1980 to 2000?
P
Population
4,117 residents of Olmsted County, Minn, diagnosed with first atrial fibrillation from 1980 to 2000 and without previous stroke.
O
Outcome
First ischemic stroke and deathhard clinical
The incidence of ischemic stroke following a first diagnosis of atrial fibrillation decreased significantly from 1980 to 2000, likely driven by increased antithrombotic use and better blood pressure control, though mortality risk remained unchanged.
Cite This Study
Miyasaka et al. (2005) studied this question.