Risk factors for stroke in patients with nonrheumatic atrial fibrillation: a case-control study.
OBJECTIVE
Randomized controlled trials have demonstrated that anticoagulant therapy is very effective at preventing stroke among patients with nonrheumatic atrial fibrillation. However, these trials have reported too few strokes for powerful risk factor analysis. Observational studies may provide additional information. The purpose of this study was to identify risk factors in a larger number of patients with stroke and nonrheumatic atrial fibrillation, using case-control methodology.


METHODS
We identified all patients discharged from one hospital over an 8-year period who met our case definition of nonrheumatic atrial fibrillation and ischemic stroke (n = 134), and compared them with contemporaneous control subjects who were discharged with nonrheumatic atrial fibrillation without stroke (n = 131).


RESULTS
Cases and controls were similar in terms of duration of atrial fibrillation; proportion with paroxysmal atrial fibrillation; percentage with a past medical history of angina, myocardial infarction, congestive heart failure, diabetes, or smoking; and mean left atrial size. In contrast, cases were significantly older than controls (78.5 versus 74.8 years, p = 0.002) and more likely to have a history of hypertension (55% versus 38%, p = 0.0093). The relative odds for stroke was 1.91 for patients with hypertension, 1.73 for patients older than 75 years, and 3.26 for patients with both factors.


CONCLUSIONS
Our analysis suggests that age and hypertension should be considered when deciding upon long-term anticoagulant therapy to prevent stroke in patients with nonrheumatic atrial fibrillation.
Moulton
A W
AW
Division of General Internal Medicine, Rhode Island Hospital, Providence 02903.
Singer
D E
DE
Haas
J S
JS
D000367:Age Factors; D001281:Atrial Fibrillation / Q000150:complications* / Q000453:epidemiology; D016022:Case-Control Studies; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000209:etiology*; D004562:Electrocardiography; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D016017:Odds Ratio; D012307:Risk Factors; D012737:Sex Factors