Preventing the Rise of Atrial Fibrillation-Related Stroke in Populations
2014; Lippincott Williams & Wilkins; Volume: 130; Issue: 15 Linguagem: Inglês
10.1161/circulationaha.114.012738
ISSN1524-4539
Autores Tópico(s)Cardiac Arrhythmias and Treatments
ResumoHomeCirculationVol. 130, No. 15Preventing the Rise of Atrial Fibrillation-Related Stroke in Populations Free AccessEditorialPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessEditorialPDF/EPUBPreventing the Rise of Atrial Fibrillation-Related Stroke in PopulationsA Call to Action Peter J. Kelly, MD, FRCPI Peter J. KellyPeter J. Kelly From the Neurovascular Unit for Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Dublin, Ireland. Originally published10 Sep 2014https://doi.org/10.1161/CIRCULATIONAHA.114.012738Circulation. 2014;130:1221–1222Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: October 7, 2014: Previous Version 1 Atrial fibrillation (AF) occurs in 1 to 1.5% of populations in developed countries and is independently associated with a 5-fold increase in stroke risk. Up to one-third of patients with first stroke in population studies have AF, with consequent greater neurological impairment, worse disability, increased recurrence risk, and more frequent dementia and requirement for institutional care compared with stroke of other causes.1,2Article see p 1236The prevalence of AF is highly age-dependent, ranging from 0.1% in those aged 80 years increased 1.5-fold, but was unchanged in those aged 80 years. Under the worst-case scenario, 156 000 strokes and systemic embolic events were projected, a 4.5-fold increase.Observed average per-patient hospital costs for AF-stroke were similar regardless of age, but costs of long-term institutional care were doubled in those aged >80 years. Under their constant-incidence scenario, annual UK costs were estimated at almost £2 billion by 2050, ≈70% of which was incurred by those aged >80 years.How are these results to be interpreted by clinicians and policy-makers within and outside the United Kingdom? First, in contrast to earlier studies of selected hospital patients, the OXVASC group used robust and rigorous methodology to minimize the possibility of selection bias, including the population-based design and overlapping ascertainment methods.9,10 Other strengths include prospective and prolonged follow-up of study participants, inclusion of posthospital community costs, and inclusion of systemic embolic events. Their crude incidence rates of AF-stroke (41/100 000 person-years) are similar to other recent population studies in Dublin and Dijon,1,11 which strengthens the validity of their findings. Similar methods for ascertainment of stroke and AF were used in OCSP and OXVASC, which reduces the likelihood that their findings relate to improved ascertainment over time. Ambulatory cardiac monitoring for paroxysmal AF was not routinely performed in either study, which may have led to underdetection of some patients with AF, but this is unlikely to have differed between the 2 studies.Second, the degree to which their findings may be generalized beyond the Oxfordshire population should be considered. Stroke incidence rates are influenced by socioeconomic profile, health behaviors, and use of vascular preventive therapies in the underlying population. The degree to which their population sample is representative of other populations or healthcare systems is unclear, as the authors rightly acknowledge. In contrast to the Oxford findings, other long-term population studies in the United States and France have observed reductions of 1.5% to 3% annually in AF-stroke incidence between the 1980s and 2000s, associated with substantial increases in the use of oral anticoagulation and other preventive therapies, despite the increasing age profile of their underlying populations.11,12The Oxford study is a timely warning call alerting clinicians, health advocates, and policy-makers of the flood of costly AF-related strokes and embolic events that may be expected if preventive action is not taken. The findings of other studies provide grounds for optimism that increases in AF-stroke are not inevitable if effective steps are taken to detect AF, assess stroke and bleeding risk, and begin appropriate prevention.13,14 To ensure that these actions are effective and equitable at population level, states and health systems should develop and implement comprehensive AF policies, supported by adequate funding.DisclosuresDr Kelly is supported by grant funding from the Health Research Board of Ireland and Irish Heart Foundation. He has received honoraria for contributions to advisory boards or conferences supported by Bayer, Pfizer, Bristol Myers Squibb, Boehringer-Ingelheim, and Daiichi Sankyo.FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.Correspondence to Peter J. Kelly, MD, FRCPI, Neurovascular Unit for Translational and Therapeutics Research, UCD/DAMC Catherine McAuley Research Centre, 27 Nelson St, Mater University Hospital, Dublin 7, Ireland. E-mail [email protected]References1. Hannon N, Sheehan O, Kelly L, Marnane M, Merwick A, Moore A, Kyne L, Duggan J, Moroney J, McCormack PM, Daly L, Fitz-Simon N, Harris D, Horgan G, Williams EB, Furie KL, Kelly PJ. Stroke associated with atrial fibrillation–incidence and early outcomes in the north Dublin population stroke study.Cerebrovasc Dis. 2010; 29:43–49.CrossrefMedlineGoogle Scholar2. Friberg L, Rosenqvist M, Lindgren A, Terént A, Norrving B, Asplund K. High prevalence of atrial fibrillation among patients with ischemic stroke.Stroke. 2014; 45:2599–2605.LinkGoogle Scholar3. Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, Singer DE. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study.JAMA. 2001; 285:2370–2375.CrossrefMedlineGoogle Scholar4. Ball J, Carrington MJ, McMurray JJ, Stewart S. Atrial fibrillation: profile and burden of an evolving epidemic in the 21st century.Int J Cardiol. 2013; 167:1807–1824.CrossrefMedlineGoogle Scholar5. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Judd SE, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Mackey RH, Magid DJ, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Neumar RW, Nichol G, Pandey DK, Paynter NP, Reeves MJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Wong ND, Woo D, Turner MB; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics – 2014 update.Circulation. 2013; 129:e28–e292LinkGoogle Scholar6. Brüggenjürgen B, Rossnagel K, Roll S, Andersson FL, Selim D, Müller-Nordhorn J, Nolte CH, Jungehülsing GJ, Villringer A, Willich SN. The impact of atrial fibrillation on the cost of stroke: the berlin acute stroke study.Value Health. 2007; 10:137–143.CrossrefMedlineGoogle Scholar7. Winter Y, Wolfram C, Schaeg M, Reese JP, Oertel WH, Dodel R, Back T. Evaluation of costs and outcome in cardioembolic stroke or TIA.J Neurol. 2009; 256:954–963.CrossrefMedlineGoogle Scholar8. Yiin GSC, Howard DPJ, Paul NLM, Li L, Luengo-Fernandez R, Bull LM, Welch SJV, Gutnikov SA, Mehta Z, Rothwell PM; on behalf of the Oxford Vascular Study. Age-specific incidence, outcome, cost, and projected future burden of atrial fibrillation-related embolic vascular events: a population-based study.Circulation. 2014; 130:1236–1244.LinkGoogle Scholar9. Feigin VL, Carter K. Stroke incidence studies one step closer to the elusive gold standard?Stroke. 2004; 35;2045–2047.LinkGoogle Scholar10. Coull AJ, Silver LE, Bull LM, Giles MF, Rothwell PM; Oxford Vascular (OXVASC) Study. Direct assessment of completeness of ascertainment in a stroke incidence study.Stroke. 2004; 35:2041–2045.LinkGoogle Scholar11. Béjot Y, Ben Salem D, Osseby GV, Couvreur G, Durier J, Marie C, Cottin Y, Moreau T, Giroud M. Epidemiology of ischemic stroke from atrial fibrillation in Dijon, France, from 1985 to 2006.Neurology. 2009; 72:346–353.CrossrefMedlineGoogle Scholar12. Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Seward JB, Bailey KR, Iwasaka T, Tsang TS. Time trends of ischemic stroke incidence and mortality in patients diagnosed with first atrial fibrillation in 1980 to 2000: report of a community-based study.Stroke. 2005; 36:2362–2366.LinkGoogle Scholar13. Camm J, Kirchhof P, Lip GYH, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N, Hindricks G, Prendergast B, Heidbuchel H, Alfieri O, Angelini A, Atar D, Colonna P, De Caterina R, De Sutter J, Goette A, Gorenek B, Heldal M, Hohloser SH, Kolh P, Le Heuzey JY, Ponikowski P, Rutten FH.. Guidelines for the management of atrial fibrillation. The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC).Eur Heart J. 2010; 31:2369–2429.CrossrefMedlineGoogle Scholar14. Camm J, Lip G, De Caterina R, Savelieva I, Atar D, Hohnloser H, Hindricks G, Kirchhof P; ESC Committee for Practice Guidelines (CPG). 2012 Focused update of the ESC guidelines for the management of atrial fibrillation.Eur Heart J. 2012; 33:2719–47.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By 马 静 (2021) Renal Infarction and Superior Mesenteric Artery Embolism Caused by Atrial Fibrillation Combined with Heart Failure: A Case Report and Literature Review, Advances in Clinical Medicine, 10.12677/ACM.2021.114233, 11:04, (1622-1629), . Guo J, Guan T, Fan S, Chao B, Wang L and Liu Y (2018) Underuse of Oral Anticoagulants in Patients With Ischemic Stroke and Atrial Fibrillation in China, The American Journal of Cardiology, 10.1016/j.amjcard.2018.08.057, 122:12, (2055-2061), Online publication date: 1-Dec-2018. Chang E, Choi S, Kwon I, Araiza D, Moore M, Trejo L and Sarkisian C (2018) Characterizing Beliefs about Stroke and Walking for Exercise among Seniors from Four Racial/Ethnic Minority Communities, Journal of Cross-Cultural Gerontology, 10.1007/s10823-018-9356-6, 33:4, (387-410), Online publication date: 1-Dec-2018. Saner H and van der Velde E (2016) eHealth in cardiovascular medicine: A clinical update, European Journal of Preventive Cardiology, 10.1177/2047487316670256, 23:2_suppl, (5-12), Online publication date: 1-Oct-2016. Wendelboe A and Raskob G (2016) Global Burden of Thrombosis, Circulation Research, 118:9, (1340-1347), Online publication date: 29-Apr-2016. Saner H (2016) E-Health and Telemedicine: Current Situation and Future Challenges, Kardiologiya i serdechno-sosudistaya khirurgiya, 10.17116/kardio2016918-12, 9:1, (8), . Hayden D, Hannon N, Callaly E, Ní Chróinín D, Horgan G, Kyne L, Duggan J, Dolan E, O'Rourke K, Williams D, Murphy S and Kelly P (2015) Rates and Determinants of 5-Year Outcomes After Atrial Fibrillation–Related Stroke, Stroke, 46:12, (3488-3493), Online publication date: 1-Dec-2015. Black-Maier E, Steinberg B and Piccini J (2015) Bucindolol hydrochloride in atrial fibrillation and concomitant heart failure, Expert Review of Cardiovascular Therapy, 10.1586/14779072.2015.1031111, 13:6, (627-636), Online publication date: 3-Jun-2015. October 7, 2014Vol 130, Issue 15 Advertisement Article InformationMetrics © 2014 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.114.012738PMID: 25208552 Originally publishedSeptember 10, 2014 Keywordsatrial fibrillationstrokeEditorialspreventionPDF download Advertisement SubjectsAnticoagulantsCerebrovascular Disease/StrokeIschemic Stroke
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