Temporal Trends of Ischemic Stroke Risk in Patients With Incident Atrial Fibrillation Before Anticoagulation
: Teppo, Konsta; Airaksinen, K.E. Juhani; Halminen, Olli; Jaakkola, Jussi; Haukka, Jari; Kouki, Elis; Luojus, Alex; Putaala, Jukka; Salmela, Birgitta; Linna, Miika; Aro, Aapo L.; Mustonen, Pirjo; Hartikainen, Juha; Lip, Gregory Y.H.; Lehto, Mika
Publisher: Elsevier BV
: 2024
: JACC: Clinical electrophysiology
: JACC: Clinical Electrophysiology
: JACC Clin Electrophysiol
: 2405-500X
: 2405-5018
DOI: https://doi.org/10.1016/j.jacep.2024.10.029
: https://doi.org/10.1016/j.jacep.2024.10.029
: https://research.utu.fi/converis/portal/detail/Publication/484252581
BACKGROUND Atrial fibrillation (AF) is a major risk factor for ischemic stroke (IS), but whether the magnitude of this risk has changed over time is unknown.
OBJECTIVES This study sought to investigate temporal trends in IS rates in patients with incident AF before oral anticoagulant agent (OAC) therapy.
METHODS The nationwide FinACAF (Finnish Anticoagulation in Atrial Fibrillation) study covers patients with AF at all levels of care in Finland from 2007 to 2018. A 4-week quarantine period from AF diagnosis was applied, and only follow-up time without OAC therapy was included. Incidence rates of IS were computed in 4-year intervals in relation to sex and non-sex CHA2DS2-VASc (ie, CHA2DS2-VA) score values.
RESULTS In total, 129,789 patients with new-onset AF were identified (49.2% women; mean age: 71.4 ± 14.5 years). Between the calendar year intervals of 2007-2010 and 2015-2018, the patients' mean CHA2DS2-VA score increased from 2.5 to 3.0, and concurrently the overall IS rate decreased by 25% from 36.7 to 27.6 events per 1,000 patient-years. This trend was driven by a 32% decrease of IS rate in women, particularly among those with higher age and CHA2DS2-VA scores. The IS rate in patients with a CHA2DS2-VA score of 1 was 8.2 events per 1,000 patient-years and remained stable across the study period.
CONCLUSIONS The initial IS risk in AF patients, before the initiation of OAC therapy, has decreased by 25% between 2007 and 2018 despite an increase in both age and stroke risk scores. The decrease has been most pronounced in older women with high stroke risk scores.
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This work was supported by the Aarne Koskelo Foundation, Finnish Foundation for Cardiovascular Research, Finnish State Research funding, and Helsinki and Uusimaa Hospital District research fund (TYH2019309). Dr Teppo has received research grants from the Finnish Foundation for Cardiovascular Research and the Aarne and Aili Turunen Foundation. Dr Airaksinen has received research grants from the Finnish Foundation for Cardiovascular Research; has served as a speaker for Bayer, Pfizer, and Boehringer Ingelheim; and has been a member of the Advisory Board for Bayer, Pfizer, and AstraZeneca. Dr Putaala has served as a speaker for Bayer, Boehringer Ingelheim, BMS-Pfizer, and Abbott; has served on the Advisory Board for Portola, Novo Nordisk, and Herantis Pharma; has served as a visiting editor for Terve Media; and holds stock ownership in Vital Signum. Dr Haukka has served as a research consultant for Janssen R&D and as a speaker for Bayer Finland. Dr Salmela has served as a speaker for BMS, Boehringer Ingelheim, and Pfizer; and has served on the Advisory Board for Pfizer. Dr Linna has served as a speaker for BMS-Pfizer Alliance, Bayer, and Boehringer Ingelheim. Aapo Aro has received research grants from the Finnish Foundation for Cardiovascular Research and has served as a speaker for Abbott, Johnson & Johnson, Sanofi, Bayer, and Boehringer Ingelheim. Dr Mustonen has served as a consultant for Roche, BMS-Pfizer Alliance, Novartis Finland, Boehringer Ingelheim, and MSD Finland. Dr Hartikainen has received research grants from the Finnish Foundation for Cardiovascular Research, European Union’s Horizon 2020, and EU FP7; has been a member of the Advisory Board for BMS-Pfizer Alliance, Novo Nordisk, and Amgen; and has served as a speaker for Cardiome and Bayer. Dr Lehto has served as a consultant for BMS-Pfizer Alliance, Bayer, Boehringer Ingelheim, and MSD; has served as a speaker for BMS-Pfizer Alliance, Bayer, Boehringer Ingelheim, MSD, Terve Media, and Orion Pharma; and has received research grants from Aarne Koskelo Foundation, the Finnish Foundation for Cardiovascular Research, Helsinki and Uusimaa Hospital District research fund, and Boehringer Ingelheim. Dr Lip has served as a consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, and Anthos (no fees were received personally) and is a National Institute for Health and Care Research senior investigator and co-principal investigator of the AFFIRMO project on multimorbidity in atrial fibrillation, which has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement no. 899871.
