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Rates and Determinants of 5-Year Outcomes After Atrial Fibrillation-Related Stroke: A Population Study.
Hayden, Derek T; Hannon, Niamh; Callaly, Elizabeth; Ní Chróinín, Danielle; Horgan, Gillian; Kyne, Lorraine; Duggan, Joseph; Dolan, Eamon; O'Rourke, Killian; Williams, David; Murphy, Sean; Kelly, Peter J.
Afiliação
  • Hayden DT; From the Stroke Department (D.T.H., E.C., D.N.C., G.H., K.O., S.M., P.J.K.), and Geriatrics Department (L.K., J.D.), Neurovascular Unit for Applied Translational Research and Therapeutics, University College Dublin/Dublin Academic Medical Centre, Mater University Hospital, Dublin, Ireland; Stroke De
  • Hannon N; From the Stroke Department (D.T.H., E.C., D.N.C., G.H., K.O., S.M., P.J.K.), and Geriatrics Department (L.K., J.D.), Neurovascular Unit for Applied Translational Research and Therapeutics, University College Dublin/Dublin Academic Medical Centre, Mater University Hospital, Dublin, Ireland; Stroke De
  • Callaly E; From the Stroke Department (D.T.H., E.C., D.N.C., G.H., K.O., S.M., P.J.K.), and Geriatrics Department (L.K., J.D.), Neurovascular Unit for Applied Translational Research and Therapeutics, University College Dublin/Dublin Academic Medical Centre, Mater University Hospital, Dublin, Ireland; Stroke De
  • Ní Chróinín D; From the Stroke Department (D.T.H., E.C., D.N.C., G.H., K.O., S.M., P.J.K.), and Geriatrics Department (L.K., J.D.), Neurovascular Unit for Applied Translational Research and Therapeutics, University College Dublin/Dublin Academic Medical Centre, Mater University Hospital, Dublin, Ireland; Stroke De
  • Horgan G; From the Stroke Department (D.T.H., E.C., D.N.C., G.H., K.O., S.M., P.J.K.), and Geriatrics Department (L.K., J.D.), Neurovascular Unit for Applied Translational Research and Therapeutics, University College Dublin/Dublin Academic Medical Centre, Mater University Hospital, Dublin, Ireland; Stroke De
  • Kyne L; From the Stroke Department (D.T.H., E.C., D.N.C., G.H., K.O., S.M., P.J.K.), and Geriatrics Department (L.K., J.D.), Neurovascular Unit for Applied Translational Research and Therapeutics, University College Dublin/Dublin Academic Medical Centre, Mater University Hospital, Dublin, Ireland; Stroke De
  • Duggan J; From the Stroke Department (D.T.H., E.C., D.N.C., G.H., K.O., S.M., P.J.K.), and Geriatrics Department (L.K., J.D.), Neurovascular Unit for Applied Translational Research and Therapeutics, University College Dublin/Dublin Academic Medical Centre, Mater University Hospital, Dublin, Ireland; Stroke De
  • Dolan E; From the Stroke Department (D.T.H., E.C., D.N.C., G.H., K.O., S.M., P.J.K.), and Geriatrics Department (L.K., J.D.), Neurovascular Unit for Applied Translational Research and Therapeutics, University College Dublin/Dublin Academic Medical Centre, Mater University Hospital, Dublin, Ireland; Stroke De
  • O'Rourke K; From the Stroke Department (D.T.H., E.C., D.N.C., G.H., K.O., S.M., P.J.K.), and Geriatrics Department (L.K., J.D.), Neurovascular Unit for Applied Translational Research and Therapeutics, University College Dublin/Dublin Academic Medical Centre, Mater University Hospital, Dublin, Ireland; Stroke De
  • Williams D; From the Stroke Department (D.T.H., E.C., D.N.C., G.H., K.O., S.M., P.J.K.), and Geriatrics Department (L.K., J.D.), Neurovascular Unit for Applied Translational Research and Therapeutics, University College Dublin/Dublin Academic Medical Centre, Mater University Hospital, Dublin, Ireland; Stroke De
  • Murphy S; From the Stroke Department (D.T.H., E.C., D.N.C., G.H., K.O., S.M., P.J.K.), and Geriatrics Department (L.K., J.D.), Neurovascular Unit for Applied Translational Research and Therapeutics, University College Dublin/Dublin Academic Medical Centre, Mater University Hospital, Dublin, Ireland; Stroke De
  • Kelly PJ; From the Stroke Department (D.T.H., E.C., D.N.C., G.H., K.O., S.M., P.J.K.), and Geriatrics Department (L.K., J.D.), Neurovascular Unit for Applied Translational Research and Therapeutics, University College Dublin/Dublin Academic Medical Centre, Mater University Hospital, Dublin, Ireland; Stroke De
Stroke ; 46(12): 3488-93, 2015 Dec.
Article em En | MEDLINE | ID: mdl-26470776
ABSTRACT
BACKGROUND AND

PURPOSE:

Demographic trends in atrial fibrillation (AF) incidence may yield a substantial rise in the societal burden of AF-related stroke (AF-stroke). Accurate population-wide outcome data are essential to inform health service planning to improve AF-stroke prevention, and provision of rehabilitation, nursing home, and community supports for AF-stroke survivors.

METHODS:

We investigated rates and determinants of 5-year fatality, stroke recurrence, functional outcomes, and prescribing of secondary prevention medications in AF-stroke in the North Dublin Population Stroke Study. Ascertainment included hot and cold pursuit using multiple overlapping sources. Survival analysis was performed using lifetables and Kaplan-Meier survival curves, and Cox proportional hazard modeling was performed to identify predictors of death and recurrent stroke.

RESULTS:

Five hundred sixty-eight patients with new stroke were identified, including 177 (31.2%) AF-stroke. At 5 years, 39.2% (confidence interval, 31.5-46.8) of ischemic AF-stroke patients were alive. Congestive heart failure, hypertension, age <65, 65-74 years, and ≥75 years, diabetes mellitus, prior stroke, transient ischemic attack or thromboembolism, vascular disease and female sex (CHA2DS2-VASc) score (hazard ratio [HR], 1.34; P<0.001), CHADS2 score (HR 1.42, P=0.004), National Institute of Health Stroke Scale (HR, 1.09; P<0.0001), and subtherapeutic international normalized ratio (<2.0) at stroke onset (HR, 3.29; P=0.003) were independently associated with 5-year fatality, whereas warfarin (HR, 0.40; P=0.001) and statin use after index stroke (HR, 0.52; P=0.005) were associated with improved survival. The 5-year recurrence rate after ischemic AF-stroke was 21.5% (confidence interval, 14.5-31.3). Trends toward greater risk of recurrence were observed for persistent AF (HR, 3.09; P=0.07) and CHA2DS2-VASc score (HR, 1.34; P=0.07). Nursing home care was needed for 25.9% of patients.

CONCLUSIONS:

AF-stroke is associated with considerable long-term morbidity, fatality, stroke recurrence, and nursing home requirement. Adequately resourced national AF strategies to improve AF detection and prevention are needed.
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Texto completo: 1 Coleções: 01-internacional Contexto em Saúde: 6_ODS3_enfermedades_notrasmisibles Base de dados: MEDLINE Assunto principal: Fibrilação Atrial / Vigilância da População / Acidente Vascular Cerebral Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies / Screening_studies Limite: Aged / Aged80 / Female / Humans / Male País/Região como assunto: Europa Idioma: En Revista: Stroke Ano de publicação: 2015 Tipo de documento: Article
Texto completo
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Buscar no Google

Texto completo: 1 Coleções: 01-internacional Contexto em Saúde: 6_ODS3_enfermedades_notrasmisibles Base de dados: MEDLINE Assunto principal: Fibrilação Atrial / Vigilância da População / Acidente Vascular Cerebral Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies / Screening_studies Limite: Aged / Aged80 / Female / Humans / Male País/Região como assunto: Europa Idioma: En Revista: Stroke Ano de publicação: 2015 Tipo de documento: Article