Article Synopsis
- Atrial fibrillation (AF) significantly increases the risk of ischemic stroke (IS), and this study examined whether this risk has changed over time in patients before starting anticoagulant therapy.
- From 2007 to 2018, the Finnish Anticoagulation in Atrial Fibrillation (FinACAF) study analyzed 129,789 new AF patients and found that the average IS rate decreased by 25%, even as the average stroke risk score (CHADS-VA) increased.
- The most notable decrease in IS rates was observed in older women with high stroke risk scores, indicating a potential shift in the management or outcomes for AF patients.
Video Abstracts
Category Ranking
98%
Total Visits
921
Avg Visit Duration
2 minutes
Citations
20
Article 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 CHADS-VASc (ie, CHADS-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 CHADS-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 CHADS-VA scores. The IS rate in patients with a CHADS-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.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.jacep.2024.10.029 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Estimated Glucose Disposal Rate and Risk of Stroke and Dementia in Nondiabetics: A UK Biobank Prospective Cohort Study.
Arterioscler Thromb Vasc Biol
September 2025
Institute of Cardiovascular Diseases and Department of Cardiology, Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu (K.L., H.M., W.J
Background: The estimated glucose disposal rate (eGDR) is a validated surrogate marker of insulin resistance. However, its association with stroke and dementia in nondiabetic populations remains insufficiently investigated.
Methods: This prospective cohort study included nondiabetic participants from the UK Biobank.
Major ABO-Incompatible Platelet Transfusions Are Associated With Brain Ischemia After Intracerebral Hemorrhage.
Stroke
September 2025
Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York. (F.C.P., M.R., M.S., A.K., S.G., S.A., S.P., J.C., D.J.R.).
Background: Major ABO-incompatible platelet transfusions are associated with poor intracerebral hemorrhage (ICH) outcomes, yet drivers for this relationship remain unclear. Brain magnetic resonance imaging (MRI) ischemic lesions after ICH are neuroimaging biomarkers of secondary brain injury and are associated with poor outcomes. Given that ABO-incompatible platelet transfusions can induce immune complex formation, thrombo-inflammation, and endothelial barrier disruption, factors that could exacerbate cerebral ischemia, we explored whether major ABO-incompatible platelet transfusions are risk factors for ischemic lesions on brain MRI after ICH.
View Article and Find Full Text PDFObservational and Experimental Evidence on the Interaction Between Fine Particulate Matter and Shared Genetic Variants Across Atherosclerotic Cardiovascular Disease Subtypes.
Circ Genom Precis Med
September 2025
Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China (J.Z., S.R., L.C., M.C., F.T., B.A., Y.Y., H.L.).
Background: Previous studies have suggested that the associations between ambient air pollution and atherosclerotic cardiovascular diseases (ASCVD) differ by genotype. A genome-wide approach provides a more comprehensive understanding of this relationship on a genomic scale.
Methods: Using data from ≈300 000 UK Biobank participants, we conducted a genome-wide interaction analysis on 10 745 802 variants.
Large-Scale Proteomics-Based Risk Score for the Prediction of Incident Cardio-Kidney-Metabolic Disease Risk.
Circ Genom Precis Med
September 2025
Division of Cardiology, Emory University School of Medicine, Atlanta, GA. (A.K.Y., A.C.R., L.S.S., A.A.Q., Y.V.S.).
Background: Cardio-kidney-metabolic (CKM) disease represents a significant public health challenge. While proteomics-based risk scores (ProtRS) enhance cardiovascular risk prediction, their utility in improving risk prediction for a composite CKM outcome beyond traditional risk factors remains unknown.
Methods: We analyzed 23 815 UK Biobank participants without baseline CKM disease, defined by -Tenth Revision codes as cardiovascular disease (coronary artery disease, heart failure, stroke, peripheral arterial disease, atrial fibrillation/flutter), kidney disease (chronic kidney disease or end-stage renal disease), or metabolic disease (type 2 diabetes or obesity).
Comparative Effectiveness of TAVI Platforms and Surgical Aortic Valve Replacement: A Network Meta-Analysis of Randomized Controlled Trials.
Circ Cardiovasc Interv
September 2025
Keele Cardiovascular Research Group, Keele University, United Kingdom (M.A.M., R.B.).
Background: Evidence informing clinical guidelines assumes that all transcatheter aortic valve implantation (TAVI) devices have similar effectiveness, in other words, displaying a class effect across TAVI valves. We aimed to assess the comparative effectiveness of different TAVI platforms relative to other TAVI counterparts or surgical aortic valve replacement (SAVR).
Methods: MEDLINE/Embase/CENTRAL were searched from inception until April 2025, for randomized controlled trials comparing outcomes with different commercially available TAVI devices relative to other TAVI counterparts or SAVR.