Risk of cerebrovascular accident after a first diagnosis of atrial fibrillation.
BACKGROUND
Atrial fibrillation is the most common cardiac arrhythmia and a major risk factor for cerebrovascular accident, including ischemic stroke and transient ischemic attack.


OBJECTIVE
Ischemic cerebrovascular accident is associated with increasing age and cardiovascular and cerebrovascular disease in primary care patients with atrial fibrillation.


METHODS
Using the U.K. General Practice Research Database, we identified patients with chronic atrial fibrillation who were alive 1 month after initial diagnosis (n = 906). Potential cases of cerebrovascular accident were identified and confirmed by the primary care physician. The incidence of cerebrovascular accident was calculated. A nested case-control analysis was performed to identify factors associated with cerebrovascular accident among patients with chronic atrial fibrillation.


RESULTS
During a mean follow-up period of 1.8 years (range: 0-3.9 years), 60 patients with atrial fibrillation were diagnosed with a new cerebrovascular accident (22 cases with transient ischemic attack and 38 with ischemic stroke). The incidence of new cerebrovascular accident was 3.6 per 100 patient-years (95% confidence interval [CI]: 2.8-4.6). Increased age (odds ratios [OR] compared with age 40-69 years: 3.5 [95% CI: 1.2-10.5] for age 70-79 years and 4.9 [95% CI: 1.6-15.0] for age > or = 80 years), prior cerebrovascular event (OR: 3.4; 95% CI: 1.9-6.1) and diabetes (OR: 2.2; 95% CI: 1.0-4.9) were identified as risk factors for a new cerebrovascular accident.


CONCLUSIONS
Among patients with atrial fibrillation, risk factors for a new ischemic cerebrovascular accident include previous ischemic stroke or transient ischemic attack, comorbid diabetes, and increasing age.
Ruigómez
Ana
A
Spanish Centre for Pharmacoepidemiological Research (CEIFE), Madrid, Spain. aruigomez@ceife.es
García Rodríguez
Luis Alberto
LA
Johansson
Saga
S
Wallander
Mari-Ann
MA
Edvardsson
Nils
N
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*
D000925:Anticoagulants