Stroke and death in elderly patients with atrial fibrillation in Japan compared with the United Kingdom.
Data on stroke, mortality and associated comorbidities in elderly patients with atrial fibrillation (AF) in Japan may differ from Western countries. There have been few systematic comparisons between stroke risk profiles and outcomes among community-based elderly (aged ≥75 years) patients with AF in Japan and the UK.



We compared clinical characteristics, stroke risk and outcomes among elderly patients with AF from the Fushimi AF Registry (Japan; N=1791) and the Darlington AF Registry (UK; N=1338).



The Fushimi cohort had a mean age 81.8 (standard deviation (SD) 5.3) years and CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years (double), diabetes mellitus, previous thromboembolism (double), vascular disease, age 65-74 years and female gender) score 4.3 (1.4), whereas the Darlington cohort had a mean age 83.6 (5.7) years and CHA2DS2-VASc score 4.4 (1.4). Over a 12-month follow-up period, observed stroke and mortality rates in Fushimi were 3.4% (n=61) and 11.5% (n=206), while corresponding event rates in the Darlington cohort were 4.4% (n=59) and 14.1% (n=188), respectively. Appropriate use of oral anticoagulation (OAC, essentially a vitamin K antagonist) was <60% in both registries.On multivariable analysis, ethnicity (Japan vs UK) was neither associated with the risk of stroke (OR 0.92, 95% CI 0.63 to 1.36; p=0.69) nor death (OR 0.92, 95% CI 0.80 to 1.27; p=0.92). In a subgroup analysis of elderly patients not receiving OAC (n=1489), a history of stroke was associated with the risk of stroke (OR 2.42, 95% CI 1.39 to 4.12; p=0.002), but not ethnicity (OR 0.86, 95% CI 0.50 to 1.47; p=0.58).



Elderly (age ≥75 years) patients with AF in both Japan and the UK are at similarly high risk of stroke and death, with OAC still underused in both populations. Ethnicity was not independently associated with the risk of stroke, regardless of OAC use or non-use.
University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK.
Keitaro
K
Senoo
Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
Yoshimori
Y
An
Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
Hisashi
H
Ogawa
University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK.
Deirdre A
DA
Lane
Division of Family Practice, Chilliwack General Hospital, Chilliwack, British Columbia, Canada.
Andreas
A
Wolff
University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK.
Eduard
E
Shantsila
Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
Masaharu
M
Akao
University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK.|Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Gregory Y H
GY
Lip
D000284:Administration, Oral; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage; D044466:Asian People; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality* / Q000517:prevention & control; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D044465:White People
D000925:Anticoagulants
Stroke