title: Risk of thromboembolism and fatal stroke in patients with psoriasis and nonvalvular atrial fibrillation: a Danish nationwide cohort study.
abstract: OBJECTIVE
  Psoriasis is a chronic inflammatory disease that is associated with a prothrombotic state and cardiovascular disease, including atrial fibrillation and thromboembolism. We therefore evaluated the impact of psoriasis in patients with atrial fibrillation and the performance of the CHA2 DS2 VASc score in these patients.
  
  
  METHODS
  The study comprised all Danish patients hospitalized with nonvalvular atrial fibrillation in the period 1997-2011 (n = 99,357). Follow-up started 7 days from discharge and excluded subjects treated with anticoagulation. Poisson regression adjusted for CHA2 DS2 VASc score was used to estimate the incidence rate ratios and 95% confidence intervals.
  
  
  METHODS
  Hospitalization or death from thromboembolism.
  
  
  RESULTS
  Mean follow-up was 3.5, 3.1, and 2.8 years for patients with no psoriasis, mild psoriasis and severe psoriasis, respectively. Patients with psoriasis were younger compared to patients without psoriasis, but CHA2DS2VASc score did not differ between the three groups. Thromboembolism rates per 100 patient-years (95% confidence intervals) were 4.8 (4.7-4.9), 4.8 (4.2-5.4) and 6.1 (5.0-7.5) for patients with no psoriasis, mild psoriasis and severe psoriasis, respectively. Importantly, the observed thromboembolism rates in patients with severe psoriasis were markedly higher (2.6- to3.4-fold) than predicted by the CHA2 DS2 VASc score. Relative to no psoriasis, incidence rate ratios were 0.99 (0.87-1.11) and 1.27 (1.02-1.57) for mild and severe psoriasis, respectively. Correspondingly, incidence rate ratios for fatal stroke were 0.97 (0.80-1.12) and 1.51 (1.12-2.05).
  
  
  CONCLUSIONS
  In patients with nonvalvular atrial fibrillation not treated with oral anticoagulation, severe psoriasis was associated with increased risk of thromboembolism. In these patients, CHA2 DS2 VASc underestimated the risk of thromboembolism.
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Roskilde, Roskilde, Denmark; Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
authors.forename: O
authors.initials: O
authors.lastname: Ahlehoff
authors.forename: G
authors.initials: G
authors.lastname: Gislason
authors.forename: M
authors.initials: M
authors.lastname: Lamberts
authors.forename: F
authors.initials: F
authors.lastname: Folke
authors.forename: J
authors.initials: J
authors.lastname: Lindhardsen
authors.forename: C T
authors.initials: CT
authors.lastname: Larsen
authors.forename: C
authors.initials: C
authors.lastname: Torp-Pedersen
authors.forename: P R
authors.initials: PR
authors.lastname: Hansen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology*; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000453:epidemiology*; D018570:Risk Assessment; D020521:Stroke / Q000401:mortality*; D013923:Thromboembolism / Q000453:epidemiology*
keywords: CHA2DS2VASc; atrial fibrillation; inflammation; psoriasis; stroke