Clinical Features and Prognosis in Patients with Atrial Fibrillation and Prior Stroke: Comparing the Fushimi and Darlington AF Registries.
BACKGROUND
Ethnic differences in clinical characteristics, stroke risk profiles and outcomes among atrial fibrillation (AF) patients may exist. We therefore compared AF patients with previous stroke from Japan and the United Kingdom (UK).


METHODS
We compared clinical characteristics, stroke risk and outcomes among AF patients from the Fushimi AF registry who had experienced a previous stroke (Japan; n=688; 19.7%) and the Darlington AF registry (UK; n=428; 19.0%).


RESULTS
AF patients with previous stroke in Fushimi were significantly younger (76.8 and 79.6years of age in Fushimi and Darlington; p<0.01) with a lower proportion of females (37.4% vs. 45.1%; p=0.01) than those from Darlington. Although the CHA2DS2-VASc score was lower in AF patients in Fushimi than those in Darlington (5.18 vs. 5.57; p<0.01), oral anticoagulation (OAC) was prescribed significantly more frequently in Fushimi (68.3%) than Darlington (61.7%) (p=0.02). Multivariate logistic regression analysis showed that Japanese ethnicity was associated with a significantly decreased risk of recurrent stroke (OR 0.59. 95% CI 0.36-0.97; p=0.04) but a significantly increased risk of all-cause mortality (OR 1.76, 95% CI 1.18-2.66; p<0.01) in AF patients with previous stroke.


CONCLUSIONS
AF patients with previous stroke in the UK were at higher risk of recurrent stroke compared to Japanese patients, but OAC was utilised less frequently. There was a lower risk of recurrent stroke in the secondary prevention cohort from the Fushimi registry, but an increased risk of all-cause mortality.
Institute of Cardiovascular Sciences, University of Birmingham, UK; Department of Cardiology, National Hospital Organization Kyoto Medical Center, Japan.
Hisashi
H
Ogawa
Institute of Cardiovascular Sciences, University of Birmingham, UK.
Keitaro
K
Senoo
Department of Cardiology, National Hospital Organization Kyoto Medical Center, Japan.
Yoshimori
Y
An
Institute of Cardiovascular Sciences, University of Birmingham, UK.
Alena
A
Shantsila
Institute of Cardiovascular Sciences, University of Birmingham, UK.
Eduard
E
Shantsila
Institute of Cardiovascular Sciences, University of Birmingham, UK.
Deirdre A
DA
Lane
Whinfield Medical Practice, Darlington, UK; Division of Family Practice, Chilliwack General Hospital, Chilliwack, British Columbia, Canada.
Andreas
A
Wolff
Department of Cardiology, National Hospital Organization Kyoto Medical Center, Japan.
Masaharu
M
Akao
Institute of Cardiovascular Sciences, University of Birmingham, UK; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. Electronic address: g.y.h.lip@bham.ac.uk.
Gregory Y H
GYH
Lip
D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D006113:United Kingdom
D000925:Anticoagulants
Atrial fibrillation; Japan; Observational; Previous stroke; Secondary prevention; United Kingdom