title: Adjuvant Chinese Herbal Products for Preventing Ischemic Stroke in Patients with Atrial Fibrillation.
abstract: OBJECTIVE
  Chinese herbal products (CHPs) are widely used for atrial fibrillation (AF) in Taiwan. We investigated the effect of adjuvant CHPs in preventing ischemic stroke in patients with AF.
  
  
  METHODS
  Taiwanese patients in the Health Insurance Database newly diagnosed with AF during 2000-2011 were enrolled. Medication treatment with/without CHPs was administered within 7 days after the AF diagnosis. The clinical endpoint was an ischemic stroke. The Chi-square test, Fisher's exact test, and Student t test were used to examine differences between the traditional Chinese medicine (TCM) and non-TCM cohorts. Cox proportional hazard regression was used to assess the risk for ischemic stroke between two cohorts.
  
  
  RESULTS
  Three hundred and eleven patients underwent TCM treatment and 1715 patients did not. Compared to non-TCM users, TCM users had a lower incidence of stroke (12.59% vs. 1.93%, respectively) and lower risk of stroke [CHA2DS2-VASc score = 0-2 (hazard ratio = 0.20; 95% confidence interval = 0.06-0.65)]. Compared to non-TCM users, the stroke risk was significantly lower in TCM users with AF who were female or younger than 65 years, but not in males, people more than 65 years old, or people with comorbidities. Compared to TCM users, non-TCM users who received conventional treatment had a higher ischemic stroke risk. The risk for AF-related hospitalization was significantly lower in TCM users (0.64%) than in non-TCM users (38.1%).
  
  
  CONCLUSIONS
  Users of TCM with AF have a lower risk of new-onset ischemic stroke. Therefore, adjuvant CHP therapy may have a protective effect and may be used in AF patients to prevent ischemic stroke.
authors.affiliation: Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.|School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Yu-Chiang
authors.initials: YC
authors.lastname: Hung
authors.affiliation: Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Yu-Chen
authors.initials: YC
authors.lastname: Cheng
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chih-Hsin
authors.initials: CH
authors.lastname: Muo
authors.affiliation: School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Hsienhsueh Elley
authors.initials: HE
authors.lastname: Chiu
authors.affiliation: Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chun-Ting
authors.initials: CT
authors.lastname: Liu
authors.affiliation: Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.|Kaohsiung Medical University College of Medicine, Kaohsiung, Taiwan.|Fooyin University College of Nursing, Kaohsiung, Taiwan.
authors.forename: Wen-Long
authors.identifier: http://orcid.org/0000-0001-9549-6202
authors.initials: WL
authors.lastname: Hu
mesh_terms: D000277:Adjuvants, Pharmaceutic / Q000627:therapeutic use*; D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D015331:Cohort Studies; D004365:Drugs, Chinese Herbal / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008516:Medicine, Chinese Traditional / Q000379:methods; D008875:Middle Aged; D008517:Phytotherapy; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012737:Sex Factors; D020521:Stroke / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000277:Adjuvants, Pharmaceutic; D004365:Drugs, Chinese Herbal