title: Time trends of ischemic stroke incidence and mortality in patients diagnosed with first atrial fibrillation in 1980 to 2000: report of a community-based study.
abstract: OBJECTIVE
  With the changes in management of atrial fibrillation (AF) over time, it is possible that the time trends of post-AF stroke incidence and mortality have changed. We sought to determine whether the incidence and survival of ischemic stroke after AF diagnosis have improved.
  
  
  METHODS
  We identified the Olmsted County, Minn, residents who developed first AF from 1980 to 2000 and followed them in medical records to 2004. The outcomes were first ischemic stroke and death.
  
  
  RESULTS
  Of the 4117 subjects diagnosed with first AF and without previous stroke, 446 (11%) sustained a first ischemic stroke during a mean follow-up time of 5.5+/-5.0 years. The age- and sex-adjusted incidence of stroke decreased, on average, by 3.4% per year (P=0.0001), concurrent with an increase in warfarin and aspirin use (both P<0.0001) and reduction of systolic blood pressure (P<0.001). The age-adjusted ischemic stroke incidence was higher in women (P=0.039), but not after adjusting for systolic blood pressure (P=0.41). Compared with the general Minnesota white 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 (P<0.05) with stroke. The relative mortality hazard did not vary by age or calendar year of AF diagnosis.
  
  
  CONCLUSIONS
  Post-AF ischemic stroke incidence decreased significantly from 1980 to 2000, during which time a substantial increase in the use of antithrombotic therapy and reduction of systolic blood pressure was evident. The relative mortality risk of stroke, however, had not improved over time.
authors.affiliation: Division of Cardiovascular Disease and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Miyasaka
authors.forename: Marion E
authors.initials: ME
authors.lastname: Barnes
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Cha
authors.forename: James B
authors.initials: JB
authors.lastname: Seward
authors.forename: Kent R
authors.initials: KR
authors.lastname: Bailey
authors.forename: Toshiji
authors.initials: T
authors.lastname: Iwasaka
authors.forename: Teresa S M
authors.initials: TS
authors.lastname: Tsang
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000494:pharmacology / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D001794:Blood Pressure; D005260:Female; D005343:Fibrinolytic Agents / Q000494:pharmacology; D006801:Humans; D015994:Incidence; D007511:Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012306:Risk; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D014859:Warfarin; D001241:Aspirin