Association of a history of falls or syncope with intracranial bleeding in patients with atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Z Oqab ◽  
A Alak ◽  
W.F McIntyre ◽  
Y.Y Liu ◽  
S.J Connolly ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Intracranial Hemorrhage ◽  
Major Bleeding ◽  
Permanent Disability ◽  
Risk Of Death ◽  
Increased Risk ◽  
History Of ◽  
Serious Injury ◽  
Critical Injury

Abstract Background In patients with atrial fibrillation (AF), anticoagulation effectively reduces the risk of ischemic stroke. However, up to 50% of patients are not receiving this treatment. A history of falls or syncope and an associated risk of intracranial hemorrhage are commonly reported reasons for undertreatment, though these have not been well studied. Purpose To investigate the association of a history of falls or syncope with the risk of intracranial hemorrhage in patients with AF. Methods Patients with a history of AF from the RE-LY, AVERROES and ACTIVE A and W trials were combined into a large cohort. “Critical injury” was defined as any injury that resulted in death, was deemed to be life-threatening or resulted in permanent disability. A “serious injury” was defined as an injury that required hospitalization. “Other injuries” were defined as those that did not meet criteria for critical or serious injury. We used logistic regression and propensity-matched Cox models to assess the association between falls or syncope and adverse outcomes. Results Among 37,973 patients, 11.9% (n=4503) had a history of falls, 17.5% (n=6655) had a history of syncope and 25.1% (n=9518) had a history of either falls or syncope. The mean age of the cohort was 71±9.3 years and 58% were male. The median CHADS2 score was 2. A history of falls or syncope was not associated with the risk of incident intracranial hemorrhage (HR 1.11, 95% CI 0.88–1.4). In propensity-matched multivariable models, a history of falls or syncope was associated with an increased risk of death (HR 1.14, 95% CI 1.07–1.22), stroke (HR 1.17, 95% CI 1.05–1.3), myocardial infarction (HR 1.28, 95% CI 1.09–1.52) and major bleeding (HR 1.27, 95% CI 1.16–1.4). Moreover, a history of falls or syncope was associated with increased risk of critical injury (OR 1.97, 95% CI 1.52–2.54), serious injury (OR 2.06, 95% CI 1.75–2.43) and “other injury” (OR 1.58, 95% CI 1.46–1.72). Conclusions A history of falls or syncope is common in patients with atrial fibrillation; however, neither history was associated with increased risk of intracranial hemorrhage. These patients were at an increased risk of death, stroke, myocardial infarction and major bleeding, suggesting that they should receive anticoagulation for stroke prevention. Funding Acknowledgement Type of funding source: None

scholarly journals Risk of ischemic stroke in patients with acute myocardial infarction and new atrial fibrillation: a nationwide analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Fauchier ◽  
A Bisson ◽  
A Bodin ◽  
J Herbert ◽  
T Genet ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Ischemic Stroke ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Risk Of Death ◽  
Increased Risk ◽  
History Of

Abstract Background In patients with acute myocardial infarction (AMI), history of atrial fibrillation (AF) and new onset AF during the early phase may be associated with a worse prognosis. Whether both conditions are associated with a similar risk of stroke and should be similarly managed is a matter of debate. Methods Based on the administrative hospital-discharge database, we collected information for all patients treated with AMI between 2010 and 2019 in France. The adverse outcomes were investigated during follow-up. Results Among 797,212 patients with STEMI or NSTEMI, 146,922 (18.4%) had history of AF, and 11,824 (1.5%) had new AF diagnosed between day 1 and day 30 after AMI. Patients with new AF were older and had more comorbidities than those with no AF but were younger and had less comorbidities than those with history of AF. Both groups with history of AF or new AF had less frequent STEMI and anterior MI, less frequent use of percutaneous coronary intervention but more frequent HF at the acute phase than patients with no AF. During follow-up (mean [SD] 1.8 [2.4] years, median [interquartile range] 0.7 [0.1–3.1] years), 163,845 deaths and 20,168 ischemic strokes were recorded. Using Cox multivariable analysis, compared to patients with no AF, history of AF was associated with a higher risk of death during follow-up (adjusted hazard ratio HR 1.06 95% CI 1.05–1.08) while this was not the case for patients with new AF (adjusted HR 0.98 95% CI 0.95–1.02). By contrast, both history of AF and new AF were associated with a higher risk of ischemic stroke during follow-up compared to patients with no AF: adjusted hazard ratio HR 1.29 95% CI 1.25–1.34 for history of AF, adjusted HR 1.72 95% CI 1.59–1.85 for new AF. New AF was associated with a higher risk of ischemic stroke than history of AF (adjusted HR 1.38 95% CI 1.27–1.49). Conclusion In a large and systematic nationwide analysis, AF first recorded in the first 30 days after AMI was associated with an increased risk of ischemic stroke. Specific management should be considered in order to improve outcomes in these patients after AMI. Funding Acknowledgement Type of funding source: None

scholarly journals The optimal drug adherence to maximize the efficacy and safety of non-vitamin K antagonist oral anticoagulant in real-world atrial fibrillation patients

EP Europace ◽  
2019 ◽  
Vol 22 (4) ◽  
pp. 547-557 ◽  
Author(s):  
Daehoon Kim ◽  
Pil-Sung Yang ◽  
Eunsun Jang ◽  
Hee Tae Yu ◽  
Tae-Hoon Kim ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Ischaemic Stroke ◽  
Clinical Outcomes ◽  
Vitamin K ◽  
Major Bleeding ◽  
Oral Anticoagulant ◽  
Vitamin K Antagonist ◽  
Increased Risk ◽  
Optimal Drug

Abstract Aims To investigate the association between adherence to non-vitamin K antagonist oral anticoagulant (NOAC) and clinical outcomes and to determine the optimal cut-off level of NOAC adherence among patients with atrial fibrillation (AF). Methods and results Using the Korean National Health Insurance Service database, we identified 96 197 patients with non-valvular AF who initiated NOAC or warfarin in 2013–16. We compared clinical outcomes between adherent [proportion of days covered (PDC) ≥80%] vs. non-adherent (PDC <80%) NOAC users, and further with warfarin users. We assessed the outcomes according to different levels of adherence. The proportion of adherent NOAC users was 64.0%. Compared with non-adherent NOAC users, adherent NOAC users were at lower risks of ischaemic stroke/systemic embolism (SE) [adjusted hazard ratio (aHR) 0.73, 95% confidence interval (CI) 0.69–0.79], and myocardial infarction (aHR 0.82, 95% CI 0.72–0.93), whereas there was no significant risk alteration for major bleeding (aHR 1.01, 95% CI 0.91–1.11). Compared with warfarin, non-adherent NOAC use failed to have better efficacy against ischaemic stroke/SE (aHR 0.99, 95% CI 0.93–1.05) and rather had increased risk of myocardial infarction (aHR 1.13, 95% CI 1.03–1.25). In NOAC users, the risks of adverse outcomes decreased according to gradual increase of adherence rates with the lowest risks in ≥90%, except for major bleeding in which there were no significant associations. Conclusions In an adherence level-dependent fashion, adherent use of NOAC showed better clinical outcomes without increasing bleeding risk. Maintaining ≥90% of adherence optimizes effectiveness of NOAC therapy without compromising its safety.

scholarly journals Atrial fibrillation and clinical outcomes 1 to 3 years after myocardial infarction

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001726
Author(s):  
Anthony P Carnicelli ◽  
Ruth Owen ◽  
Stuart J Pocock ◽  
David B Brieger ◽  
Satoshi Yasuda ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Clinical Outcomes ◽  
Oral Anticoagulants ◽  
Adverse Outcomes ◽  
Increased Risk ◽  
History Of ◽  
The Impact

ObjectiveAtrial fibrillation (AF) and myocardial infarction (MI) are commonly comorbid and associated with adverse outcomes. Little is known about the impact of AF on quality of life and outcomes post-MI. We compared characteristics, quality of life and clinical outcomes in stable patients post-MI with/without AF.Methods/resultsThe prospective, international, observational TIGRIS (long Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease) registry included 8406 patients aged ≥50 years with ≥1 atherothrombotic risk factor who were 1–3 years post-MI. Patient characteristics were summarised by history of AF. Quality of life was assessed at baseline using EQ-5D. Clinical outcomes over 2 years of follow-up were compared. History of AF was present in 702/8277 (8.5%) registry patients and incident AF was diagnosed in 244/7575 (3.2%) over 2 years. Those with AF were older and had more comorbidities than those without AF. After multivariable adjustment, patients with AF had lower self-reported quality-of-life scores (EQ-5D UK-weighted index, visual analogue scale, usual activities and pain/discomfort) than those without AF. CHA2DS2-VASc score ≥2 was present in 686/702 (97.7%) patients with AF, although only 348/702 (49.6%) were on oral anticoagulants at enrolment. Patients with AF had higher rates of all-cause hospitalisation (adjusted rate ratio 1.25 [1.06–1.46], p=0.008) over 2 years than those without AF, but similar rates of mortality.ConclusionsIn stable patients post-MI, those with AF were commonly undertreated with oral anticoagulants, had poorer quality of life and had increased risk of clinical outcomes than those without AF.Trial registration numberClinicalTrials: NCT01866904.

Abstract 12465: Dabigatran in Real World of Atrial Fibrillation: Systematic Review and Meta-analysis of Comparison Studies With Vitamin K Antagonists

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
João Carmo ◽  
Francisco M Costa ◽  
Jorge Ferreira ◽  
Miguel Mendes
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Systematic Review ◽  
Intracranial Hemorrhage ◽  
Vitamin K ◽  
Major Bleeding ◽  
Real World ◽  
Observational Studies ◽  
Meta Analysis ◽  
Vitamin K Antagonists

Background: In the clinical trial RE-LY, dabigatran showed a better efficacy/safety profile in comparison with warfarin, but clinical trials are few representative of the real world. We aim to access if dabigatran in real-world patients with atrial fibrillation (AF) showed a better profile in comparison with warfarin, through a systematic review and meta-analysis of observational studies comparing with vitamin K antagonists. Methods: PubMed, Embase and Scopus databases were searched through December 2014. We include observational studies comparing dabigatran to warfarin for non-valvular AF that reported clinical events during a follow-up for dabigatran 75mg, 110 mg or 150 mg, and warfarin. We proceeded to the extraction and analysis of data for clinical thromboembolic events, bleeding and mortality. Data were pooled by meta-analysis using a random-effects model. Results: We selected 9 studies involving a total of 291,703 patients, 85,399 treated with dabigatran and the remaining 206,304 with warfarin. The incidence of stroke was 1.71 / 100 patient-years for dabigatran and 2.44 / 100 patient years for warfarin (relative risk [RR] 0.91, 95% CI 0.66 to 1.27, p=0.58). The major bleeding rate was 3.90 / 100 patient-years for dabigatran and 3.92 / 100 patient years for warfarin (RR 0.90; 0.78 to 1.03, p=0.11). The all-cause mortality (RR 0.81, 0.75-0.88, p<0.001) and intracranial hemorrhage (RR 0.45, from 0.27 to 0.76, p=0.002) were significantly lower in patients treated with dabigatran in comparison to those treated with warfarin. There were no significant differences in risk of myocardial infarction (RR 0.55; 0.29 to 1.07, p=0.08), total hemorrhage (RR 1.00; 0.57 to 1.77, p=0.99), and gastro-intestinal bleeding (RR 1.14; 0.78 to 1.69, p=0.50). Conclusions: In this combined analysis of observational studies of real world, dabigatran compared to warfarin was associated with a similar risk of stroke, myocardial infarction, major bleeding, total bleeding and gastrointestinal bleeding, and a lower risk of intracranial hemorrhage and mortality.

P4747Impact of different estimates of renal function on cardiovascular mortality and major bleeding in patients with atrial fibrillation on oral anticoagulation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Z Hijazi ◽  
C B Granger ◽  
S H Hohnloser ◽  
J Westerbergh ◽  
J Lindback ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
New York ◽  
Cystatin C ◽  
Major Bleeding ◽  
Discriminatory Ability ◽  
Risk Of Death ◽  
Model Based ◽  
Increased Risk ◽  
Individual Variables ◽  
The Individual

Abstract Background Renal dysfunction is associated with increased risk of cardiovascular events in atrial fibrillation (AF). Estimated glomerular filtration rate (eGFR) can be calculated by different equations based on creatinine or cystatin C. We compared different methods of assessing eGFR and their association with cardiovascular (CV) death and major bleeding in 14,980 AF patients in the ARISTOTLE trial. Methods eGFR was calculated using equations based on creatinine (Cockcroft-Gault, MDRD, and CKD-EPI) and/or cystatin C (CKD-EPIcys and CKD-EPIcys+crea). In total five eGFR equations as well as a model based on the variables within the equations were assessed. Associations were evaluated by Spearman correlation, and discriminatory ability for CV-death and major bleeding by Harrell's c-index. Results Median age was 70.0 years, and 35.6% were women. Median eGFR (mL/min) were: Cockcroft-Gault 74.1, MDRD 66.5, CKD-EPI 68.5, CKD-EPIcys 74.2, and CKD-EPIcys+crea 72.6. Correlation ranged from 0.49 (Cockroft-Gault and CKD-EPIcys) to 0.99 (MDRD and CKD-EPI). Among the eGFR equations, those based on cystatin C yielded the highest c-indices for CV-death and major bleeding, 0.628 (CKD-EPIcys) and 0.612 (CKD-EPIcys+crea), respectively. A model based on the variables within the eGFR equations (age, sex, weight, creatinine, and cystatin C) yielded the highest discriminatory value for both outcomes, 0.673 and 0.656, respectively. Figure 1 Conclusions In patients with AF on anticoagulation, correlation between eGFR methods varied greatly. Cystatin C-based eGFR seem to provide the most robust balance in reflecting the risk of death and bleeding. However, a model based on the individual variables within the eGFR equations provided the highest discriminatory value. Acknowledgement/Funding The ARISTOTLE trial was funded by Bristol-Myers Squibb, Co Princeton, NJ and Pfizer Inc., New York, NY.

Anticoagulation in patients with atrial fibrillation undergoing coronary stent implantation

2013 ◽  
Vol 110 (09) ◽  
pp. 560-568 ◽  
Author(s):  
Anne Bernard ◽  
Céline Pellegrin ◽  
Nicolas Clementy ◽  
Christophe Saint Etienne ◽  
Amitava Banerjee ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stent Implantation ◽  
Target Lesion ◽  
Coronary Stent ◽  
Cardiac Events ◽  
Risk Of Death ◽  
Coronary Stent Implantation ◽  
Increased Risk ◽  
History Of ◽  
Artery Disease

SummaryIn patients with atrial fibrillation (AF) undergoing coronary stent implantation, the optimal antithrombotic strategy is unclear. We evaluated whether use of oral anticoagulation (OAC) was associated with any benefit in morbidity or mortality in patients with AF, high risk of thromboembolism (TE) (CHA2DS2-VASC score ≥2) and coronary stent implantation. Among 8,962 unselected patients with AF seen between 2000 and 2010, a total of 2,709 (30%) had coronary artery disease and 417/2,709 (15%) underwent stent implantation while having CHA2DS2-VASC score ≥2. During follow-up (median=650 days), all TE, bleeding episodes, and major adverse cardiac events (i.e. death, acute myocardial infarction, target lesion revascularisation) were recorded. At discharge, 97/417 patients (23%) received OAC, which was more likely to be prescribed in patients with permanent AF and in those treated for elective stent implantation. The incidence of outcome event rates was not significantly different in patients treated and those not treated with OAC. However, in multivariate analysis, the lack of OAC at discharge was independently associated with increased risk of death/stroke/systemic TE (relative risk [RR] =2.18, 95% confidence interval [CI] 1.02-4.67, p=0.04), with older age (RR =1.12, 1.04-1.20, p=0.003), heart failure (RR =3.26, 1.18-9.01, p=0.02), and history of stroke (RR =18.87, 3.11-111.11, p=0.001). In conclusion, in patients with AF and high thromboembolic risk after stent implantation, use of OAC was independently associated with decreased risk of subsequent death/stroke/systemic TE, suggesting that OAC should be systematically used in this patient population.

scholarly journals Development of atrial fibrillation following trauma increases short term risk of cardiovascular events

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Sean P. Nassoiy ◽  
Robert H. Blackwell ◽  
McKenzie Brown ◽  
Anai N. Kothari ◽  
Timothy P. Plackett ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Cardiovascular Events ◽  
Prior History ◽  
Trauma Patients ◽  
Index Hospitalization ◽  
Inpatient Mortality ◽  
Increased Risk ◽  
History Of ◽  
New Onset

Abstract Context New onset atrial fibrillation (AF) is associated with poor outcomes in several different patient populations. Objectives To assess the effect of developing AF on cardiovascular events such as myocardial infarction (MI) and cerebrovascular accident (CVA) during the acute index hospitalization for trauma patients. Methods The Healthcare Cost and Utilization Project State Inpatient Databases for California and Florida were used to identify adult trauma patients (18 years of age or older) who were admitted between 2007 and 2010. After excluding patients with a history of AF and prior history of cardiovascular events, patients were evaluated for MI, CVA, and death during the index hospitalization. A secondary analysis was performed using matched propensity scoring based on age, race, and preexisting comorbidities. Results During the study period, 1,224,828 trauma patients were admitted. A total of 195,715 patients were excluded for a prior history of AF, MI, or CVA. Of the remaining patients, 15,424 (1.5%) met inclusion criteria and had new onset AF after trauma. There was an associated increase in incidence of MI (2.9 vs. 0.7%; p<0.001), CVA (2.6 vs. 0.4%; p<0.001), and inpatient mortality (8.5 vs. 2.1%; p<0.001) during the index hospitalization in patients who developed new onset AF compared with those who did not. Cox proportional hazards regression demonstrated an increased risk of MI (odds ratio [OR], 2.35 [2.13–2.60]), CVA (OR, 3.90 [3.49–4.35]), and inpatient mortality (OR, 2.83 [2.66–3.00]) for patients with new onset AF after controlling for all other potential risk factors. Conclusions New onset AF in trauma patients was associated with increased incidence of myocardial infarction (MI), cerebral vascular accident (CVA), and mortality during index hospitalization in this study.

scholarly journals Compared prognostic impact of incident atrial fibrillation versus history of atrial fibrillation in patients with AMI: the FAST-MI programme

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Danchin ◽  
L Fauchier ◽  
E Marijon ◽  
T Lavergne ◽  
S Boveda ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulants ◽  
Acute Stage ◽  
Funding Source ◽  
Prognostic Impact ◽  
Risk Of Death ◽  
Fatal Stroke ◽  
Increased Risk ◽  
History Of ◽  
Using Data

Abstract Background History of atrial fibrillation (HxAF) and new onset atrial fibrillation (NOAF) at acute stage of MI are associated with poorer survival. Whether both entities carry an increased risk of stroke is uncertain. Using data from the FAST-MI 2010 and 2015 registries, we analysed the associations between HxAF and NOAF and risk of 3-year death, nonfatal stroke or combined death or stroke. Methods The FAST-MI registries are nationwide French cohorts consecutively including AMI patients admitted over a 1-month period every 5 years. Baseline characteristics, acute management and medications at discharge are collected. Among 9460 patients with STEMI or NSTEMI, 610 (6.4%) had HxAF, and 626 (6.6%) developed NOAF. Main characteristics Table 1 Overall, NOAF was associated with larger and more severe AMIs. Results In hospital survivors, 3-year death was 8.6% in patients without AF, 23.2% in those with NOAF and 29.2% in those with HxAF. 3-year Kaplan-Meier rates of non-fatal stroke were 1.1%, 0.3% and 3.6%, respectively (Figure). Compared with no AF, NOAF was not associated with non-fatal stroke (Cox HR, 95% CI: 0.17, 0.02–1.21), while HxAF was (HR, 95% CI 2.04, 1.13–3.66, P=0.017). Risk of death or stroke was increased for both NOAF (HR, 95% CI 1.35, 1.10–1.65, P=0.004) and HxAF (HR 95% CI, 1.37, 1.14–1.65, P=0.001). Risk of all-cause death at 3 years was increased for NOAF (HR, 95% CI 1.32, 1.09–1.60) and HxAF (HR, 95% CI 1.30, 1.09–1.55). The results were concordant in patients not receiving oral anticoagulants at discharge. Conclusion Both NOAF and HxAF are associated with increased risk of death at 3 years after AMI. NOAF, however, is not associated with an increased risk of non-fatal stroke. Figure 1. Non-fatal stroke Funding Acknowledgement Type of funding source: Other. Main funding source(s): Pharma companies

Abstract 12691: The Combination of Depression and Diabetes is Associated With Short-Term Risk of Death and Myocardial Infarction Among Patients Undergoing Angiography for Acute Coronary Syndrome

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Heidi T May ◽  
Stacey Knight ◽  
Jeffrey L Anderson ◽  
Benjamin D Horne ◽  
Viet T Le ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Collaborative Study ◽  
Prior History ◽  
Short Term ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
History Of ◽  
Cv Disease

Background: Depression and diabetes have been shown to be associated with adverse cardiovascular (CV) events. However, whether there is an increased risk when both conditions are present is unknown. Methods: Patients of the Intermountain Heart Collaborative Study were studied if they underwent angiography for acute coronary syndrome (ACS) and had no prior history of CV disease (no CAD [coronary artery disease], MI [myocardial infarction], stroke, or heart failure). Patients were stratified based on their diabetes and depression status: none, diabetes only, depression only, and diabetes and depression. Multivariable Cox hazard regression was utilized to evaluate the association of diabetes/depression groups to death and MI at 30 days, 6 months, and 1 year. Results: A total of 4,321 (62.7% male; 61.3±12.9 years) patients were studied. The distribution of patients within each diabetes/depression category was: no depression or diabetes: 74.9% (3,236), diabetes only: 18.5% (800), depression only: 4.4% (192), diabetes and depression: 2.2% (93). A total of 46.2% presented with an MI and 61.4% were diagnosed with CAD. Those with both a diabetes and depression diagnosis were at greater risk of short-term death and, in particular, MI (Table). Conclusion: Among those without a history of CV disease undergoing angiography for ACS, the presence of both diabetes and depression indicated a higher risk of short-term death and, in particular, incident MI, than either one alone or neither diagnosis. Such patients may need greater care and evaluation following angiography for ACS in an effort to reduce short-term morbidity and mortality.

scholarly journals Social isolation and loneliness as risk factors for myocardial infarction, stroke and mortality: UK Biobank cohort study of 479 054 men and women

Heart ◽  
2018 ◽  
Vol 104 (18) ◽  
pp. 1536-1542 ◽  
Author(s):  
Christian Hakulinen ◽  
Laura Pulkki-Råback ◽  
Marianna Virtanen ◽  
Markus Jokela ◽  
Mika Kivimäki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Social Isolation ◽  
Uk Biobank ◽  
Risk Of Death ◽  
Increased Risk ◽  
History Of ◽  
The Uk ◽  
Adjusted Model ◽  
Conventional Risk Factors

ObjectiveTo examine whether social isolation and loneliness (1) predict acute myocardial infarction (AMI) and stroke among those with no history of AMI or stroke, (2) are related to mortality risk among those with a history of AMI or stroke, and (3) the extent to which these associations are explained by known risk factors or pre-existing chronic conditions.MethodsParticipants were 479 054 individuals from the UK Biobank. The exposures were self-reported social isolation and loneliness. AMI, stroke and mortality were the outcomes.ResultsOver 7.1 years, 5731 had first AMI, and 3471 had first stroke. In model adjusted for demographics, social isolation was associated with higher risk of AMI (HR 1.43, 95% CI 1.3 to –1.55) and stroke (HR 1.39, 95% CI 1.25 to 1.54). When adjusted for all the other risk factors, the HR for AMI was attenuated by 84% to 1.07 (95% CI 0.99 to 1.16) and the HR for stroke was attenuated by 83% to 1.06 (95% CI 0.96 to 1.19). Loneliness was associated with higher risk of AMI before (HR 1.49, 95% CI 1.36 to 1.64) but attenuated considerably with adjustments (HR 1.06, 95% CI 0.96 to 1.17). This was also the case for stroke (HR 1.36, 95% CI 1.20 to 1.55 before and HR 1.04, 95% CI 0.91 to 1.19 after adjustments). Social isolation, but not loneliness, was associated with increased mortality in participants with a history of AMI (HR 1.25, 95% CI 1.03 to 1.51) or stroke (HR 1.32, 95% CI 1.08 to 1.61) in the fully adjusted model.ConclusionsIsolated and lonely persons are at increased risk of AMI and stroke, and, among those with a history of AMI or stroke, increased risk of death. Most of this risk was explained by conventional risk factors.

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