Stroke risk prediction in patients with atrial fibrillation with and without rheumatic heart disease

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Stroke risk prediction in patients with atrial fibrillation with and without rheumatic heart disease

Benz, Alexander P. (author): McMaster Univ, Populat Hlth Res Inst, Div Cardiol, 237 Barton St, Hamilton, ON L8L 2X2, Canada.

Healey, Jeff S. (author): McMaster Univ, Populat Hlth Res Inst, Div Cardiol, 237 Barton St, Hamilton, ON L8L 2X2, Canada.

Chin, Ashley (author): Univ Caape Town, Groote Schuur Hosp, Dept Med, Cardiac Clin, Cape Town, South Africa.

Commerford, Patrick (author): Univ Caape Town, Groote Schuur Hosp, Dept Med, Cardiac Clin, Cape Town, South Africa.

Marsden, Tamara (author): McMaster Univ, Populat Hlth Res Inst, Div Cardiol, 237 Barton St, Hamilton, ON L8L 2X2, Canada.

Karthikeyan, Ganesan (author): All India Inst Med Sci, Dept Cardiol, New Delhi, India.

McIntyre, William F. (author): McMaster Univ, Populat Hlth Res Inst, Div Cardiol, 237 Barton St, Hamilton, ON L8L 2X2, Canada.

Wong, Jorge A. (author): McMaster Univ, Populat Hlth Res Inst, Div Cardiol, 237 Barton St, Hamilton, ON L8L 2X2, Canada.

Damasceno, Albertino (author): Eduardo Mondlane Univ, Fac Med, Dept Med, Maputo, Mozambique.

Hohnloser, Stefan H. (author): Goethe Univ Frankfurt, Dept Cardiol, Div Clin Electrophysiol, Frankfurt, Germany.

Oldgren, Jonas, 1964- (author): Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Institutionen för medicinska vetenskaper

Wallentin, Lars, 1943- (author): Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Institutionen för medicinska vetenskaper

Ezekowitz, Michael D. (author): Thomas Jefferson Univ, Dept Med, Sidney Kimmel Med Coll, Lankenau & Bryn Mawr Hosp, Philadelphia, PA 19107 USA.

Eikelboom, John W. (author): McMaster Univ, Populat Hlth Res Inst, Div Cardiol, 237 Barton St, Hamilton, ON L8L 2X2, Canada.

Yusuf, Salim (author): McMaster Univ, Populat Hlth Res Inst, Div Cardiol, 237 Barton St, Hamilton, ON L8L 2X2, Canada.

Connolly, Stuart J. (author): McMaster Univ, Populat Hlth Res Inst, Div Cardiol, 237 Barton St, Hamilton, ON L8L 2X2, Canada.

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McMaster Univ, Populat Hlth Res Inst, Div Cardiol, 237 Barton St, Hamilton, ON L8L 2X2, Canada Univ Caape Town, Groote Schuur Hosp, Dept Med, Cardiac Clin, Cape Town, South Africa. (creator_code:org_t)

2021-01-02
2021
English.
In: Cardiovascular Research. - : Oxford University Press. - 0008-6363 .- 1755-3245. ; 118:1, s. 295-304

Related links:: https://urn.kb.se/re...; show more...; https://doi.org/10.1...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

Aims Patients with atrial fibrillation (AF) and rheumatic heart disease (RHD), especially mitral stenosis, are assumed to be at high risk of stroke, irrespective of other factors. We aimed to re-evaluate stroke risk factors in a contemporary cohort of AF patients. Methods and results We analysed data of 15 400 AF patients presenting to an emergency department and who were enrolled in the global RE-LY AF registry, representing 47 countries from all inhabited continents. Follow-up occurred at 1 year after enrolment. A total of 1788 (11.6%) patients had RHD. These patients were younger (51.4 +/- 15.7 vs. 67.8 +/- 13.6 years), more likely to be female (66.2% vs. 44.7%) and had a lower mean CHA(2)DS(2)-VASc score (2.1 +/- 1.7 vs. 3.7 +/- 2.2) as compared to patients without RHD (all P<0.001). Significant mitral stenosis (average mean transmitral gradient 11.5 +/- 6.5 mmHg) was the predominant valve lesion in those with RHD (59.6%). Patients with RHD had a higher baseline rate of anticoagulation use (60.4% vs. 45.2%, P<0.001). Unadjusted stroke rates at 1 year were 2.8% and 4.1% for patients with and without RHD, respectively. The performance of the CHA(2)DS(2)-VASc score was modest in both groups [stroke at 1 year, c-statistics 0.69, 95% confidence interval (CI) 0.60-0.78 and 0.63, 95% CI 0.61-0.66, respectively]. In the overall cohort, advanced age, female sex, prior stroke, tobacco use, and non-use of anticoagulation were predictors for stroke (all P<0.05). Mitral stenosis was not associated with stroke risk (adjusted odds ratio 1.07, 95% CI 0.67-1.72, P=0.764). Conclusion The performance of the CHA(2)DS(2)-VASc score was modest in AF patients both with and without RHD. In this cohort, moderate-to-severe mitral stenosis was not an independent risk factor for stroke.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Keyword

Rheumatic heart disease
Mitral stenosis
Atrial fibrillation
Stroke
Valvular

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art (subject category)

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By the author/editor: Benz, Alexander ...; Healey, Jeff S.; Chin, Ashley; Commerford, Patr ...; Marsden, Tamara; Karthikeyan, Gan ...; show more...; McIntyre, Willia ...; Wong, Jorge A.; Damasceno, Alber ...; Hohnloser, Stefa ...; Oldgren, Jonas, ...; Wallentin, Lars, ...; Ezekowitz, Micha ...; Eikelboom, John ...; Yusuf, Salim; Connolly, Stuart ...; show less...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Cardiac and Card ...

Articles in the publication: Cardiovascular R ...

By the university: Uppsala University

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