Temporal Trends of Ischemic Stroke Risk in Patients With Incident Atrial Fibrillation Before Anticoagulation

Konsta Teppo; K. E. Juhani Airaksinen; Olli Halminen; Jussi Jaakkola; Jari Haukka; Elis Kouki; Alex Luojus; Jukka Putaala; Birgitta Salmela; Miika Linna; Aapo L. Aro; Pirjo Mustonen; Juha Hartikainen; Gregory Y. H. Lip; Mika Lehto

doi:10.1016/j.jacep.2024.10.029

Temporal Trends of Ischemic Stroke Risk in Patients With Incident Atrial Fibrillation Before Anticoagulation

Konsta Teppo^*, K. E. Juhani Airaksinen, Olli Halminen, Jussi Jaakkola, Jari Haukka, Elis Kouki, Alex Luojus, Jukka Putaala, Birgitta Salmela, Miika Linna, Aapo L. Aro, Pirjo Mustonen, Juha Hartikainen, Gregory Y. H. Lip, Mika Lehto

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Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Abstract

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.

Originalsprog	Engelsk
Tidsskrift	JACC: Clinical Electrophysiology
Antal sider	10
ISSN	2405-500X
DOI	https://doi.org/10.1016/j.jacep.2024.10.029
Status	E-pub ahead of print - 18 dec. 2024

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10.1016/j.jacep.2024.10.029Licens: CC BY 4.0

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Teppo, K., Airaksinen, K. E. J., Halminen, O., Jaakkola, J., Haukka, J., Kouki, E., Luojus, A., Putaala, J., Salmela, B., Linna, M., Aro, A. L., Mustonen, P., Hartikainen, J., Lip, G. Y. H., & Lehto, M. (2024). Temporal Trends of Ischemic Stroke Risk in Patients With Incident Atrial Fibrillation Before Anticoagulation. JACC: Clinical Electrophysiology. Advance online publication. https://doi.org/10.1016/j.jacep.2024.10.029

@article{e851c8133aa740d1b04306e5675feab4,

title = "Temporal Trends of Ischemic Stroke Risk in Patients With Incident Atrial Fibrillation Before Anticoagulation",

abstract = "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.",

author = "Konsta Teppo and Airaksinen, {K. E. Juhani} and Olli Halminen and Jussi Jaakkola and Jari Haukka and Elis Kouki and Alex Luojus and Jukka Putaala and Birgitta Salmela and Miika Linna and Aro, {Aapo L.} and Pirjo Mustonen and Juha Hartikainen and Lip, {Gregory Y. H.} and Mika Lehto",

year = "2024",

month = dec,

day = "18",

doi = "10.1016/j.jacep.2024.10.029",

language = "English",

journal = "JACC: Clinical Electrophysiology",

issn = "2405-500X",

publisher = "Elsevier",

}

Teppo, K, Airaksinen, KEJ, Halminen, O, Jaakkola, J, Haukka, J, Kouki, E, Luojus, A, Putaala, J, Salmela, B, Linna, M, Aro, AL, Mustonen, P, Hartikainen, J, Lip, GYH & Lehto, M 2024, 'Temporal Trends of Ischemic Stroke Risk in Patients With Incident Atrial Fibrillation Before Anticoagulation', JACC: Clinical Electrophysiology. https://doi.org/10.1016/j.jacep.2024.10.029

TY - JOUR

T1 - Temporal Trends of Ischemic Stroke Risk in Patients With Incident Atrial Fibrillation Before Anticoagulation

AU - Teppo, Konsta

AU - Airaksinen, K. E. Juhani

AU - Halminen, Olli

AU - Jaakkola, Jussi

AU - Haukka, Jari

AU - Kouki, Elis

AU - Luojus, Alex

AU - Putaala, Jukka

AU - Salmela, Birgitta

AU - Linna, Miika

AU - Aro, Aapo L.

AU - Mustonen, Pirjo

AU - Hartikainen, Juha

AU - Lip, Gregory Y. H.

AU - Lehto, Mika

PY - 2024/12/18

Y1 - 2024/12/18

N2 - 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.

AB - 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.

U2 - 10.1016/j.jacep.2024.10.029

DO - 10.1016/j.jacep.2024.10.029

M3 - Journal article

C2 - 39708034

SN - 2405-500X

JO - JACC: Clinical Electrophysiology

JF - JACC: Clinical Electrophysiology

ER -

Temporal Trends of Ischemic Stroke Risk in Patients With Incident Atrial Fibrillation Before Anticoagulation

Abstract

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