scholarly journals Statin Adherence Is Associated With Reduced Recurrent Stroke Risk in Patients With or Without Atrial Fibrillation

Stroke ◽  
2017 ◽  
Vol 48 (7) ◽  
pp. 1788-1794 ◽  
Author(s):  
Alexander C. Flint ◽  
Carol Conell ◽  
Xiushui Ren ◽  
Hooman Kamel ◽  
Sheila L. Chan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Statin Adherence

Recurrent Stroke Risk in Pilots with Atrial Fibrillation

2020 ◽  
Vol 91 (4) ◽  
pp. 352-357
Author(s):  
Jessica Tedford ◽  
Valerie Skaggs ◽  
Ann Norris ◽  
Farhad Sahiar ◽  
Charles Mathers
Keyword(s):  
Atrial Fibrillation ◽  
General Population ◽  
Recurrent Events ◽  
Stroke Risk ◽  
Event Rate ◽  
Recurrent Stroke ◽  
Previous History ◽  
Recurrent Event ◽  
Recurrence Rates ◽  
Medical Certification

INTRODUCTION: Atrial fibrillation (AF) is one of the most common cardiac arrhythmias in the general population and is considered disqualifying aeromedically. This study is a unique examination of significant outcomes in aviators with previous history of both AF and stroke.METHODS: Pilots examined by the FAA between 2002 and 2012 who had had AF at some point during his or her medical history were reviewed, and those with an initial stroke or transient ischemic attack (TIA) during that time period were included in this study. All records were individually reviewed to determine stroke and AF history, medical certification history, and recurrent events. Variables collected included medical and behavior history, stroke type, gender, BMI, medication use, and any cardiovascular or neurological outcomes of interest. Major recurrent events included stroke, TIA, cerebrovascular accident, death, or other major events. These factors were used to calculate CHA2DS2-VASc scores.RESULTS: Of the 141 pilots selected for the study, 17.7% experienced a recurrent event. At 6 mo, the recurrent event rate was 5.0%; at 1 yr, 5.8%; at 3 yr 6.9%; and at 5 yr the recurrent event rate was 17.3%. No statistical difference between CHA2DS2-VASc scores was found as it pertained to number of recurrent events.DISCUSSION: We found no significant factors predicting risk of recurrent event and lower recurrence rates in pilots than the general population. This suggests CHA2DS2-VASc scores are not appropriate risk stratification tools in an aviation population and more research is necessary to determine risk of recurrent events in aviators with atrial fibrillation.Tedford J, Skaggs V, Norris A, Sahiar F, Mathers C. Recurrent stroke risk in pilots with atrial fibrillation. Aerosp Med Hum Perform. 2020; 91(4):352–357.

Abstract TMP100: Outpatient Statin Adherence is Associated with Reduced Recurrent Stroke Risk in Patients with or without Atrial Fibrillation

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Alexander C Flint ◽  
Carol Conell ◽  
Xiushui Ren ◽  
Sheila L Chan ◽  
Vivek A Rao ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Recurrent Stroke ◽  
Healthcare Delivery ◽  
Survival Models ◽  
Healthcare Delivery System ◽  
Race Ethnicity ◽  
Statin Adherence ◽  
The Relationship

Outpatient statin use is known to reduce the risk of recurrent ischemic stroke of atherothrombotic etiology, but it is not known whether statins have similar effects in ischemic stroke associated with atrial fibrillation (AF). We examined the relationship between outpatient statin adherence and the risk of recurrent ischemic stroke in patients with or without AF in a large integrated healthcare delivery system. Among 6,283 patients with ischemic stroke discharged on a statin over a 5 year period, 1,486 (23.7%) had a diagnosis of AF at discharge. Statin adherence rates, measured as percentage of days covered (PDC), averaged 85% (88% for AF patients and 84% for non-AF patients). We observed up to three years after the initial stroke, with an average of two years follow up. In multivariable survival models, after controlling for age, gender, race/ethnicity, and key medical comorbidities, higher statin adherence was found to strongly predict a reduced risk of recurrent ischemic stroke (Figure). In the second year post-stroke, the hazard ratio (HR) associated with a 10% increase in PDC was 0.93 (95% C.I. 0.89-097). The relationship between statin adherence and reduced stroke rates was similar in AF patients (HR 0.94, 95% C.I. 0.84-0.98) and non-AF patients (HR 0.93, 95% C.I. 0.88-0.98). These findings support the use of outpatient statins in all ischemic stroke patients, irrespective of stroke etiology (atherothrombotic vs. atrial fibrillation).

scholarly journals Unrecognized History of Transient Atrial Fibrillation at the Time of Discharge from an Index Stroke Hospitalization Is Associated with Increased Recurrent Stroke Risk

2019 ◽  
Vol 21 (2) ◽  
pp. 190-194
Author(s):  
Chia-Yu Hsu ◽  
Daniel E. Singer ◽  
Hooman Kamel ◽  
Yi-Ling Wu ◽  
Pei-Chun Chen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Index Stroke ◽  
History Of

A New Arrhythmia

2016 ◽  
Author(s):  
Ji Y. Chong ◽  
Michael P. Lerario
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Lower Risk ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Oral Anticoagulants ◽  
Novel Oral Anticoagulants ◽  
Bleeding Complications ◽  
The Novel ◽  
Risk Of Bleeding

Atrial fibrillation is a potent risk factor for stroke. Anticoagulation significantly lowers recurrent stroke risk in patients with atrial fibrillation. The novel oral anticoagulants offer options in addition to warfarin, and they are associated with lower risk of bleeding complications.

Delayed diagnosis of atrial fibrillation after first-ever stroke increases recurrent stroke risk: a 5-year nationwide follow-up study

2018 ◽  
Vol 48 (6) ◽  
pp. 661-667 ◽  
Author(s):  
Ping-Song Chou ◽  
Bo-Lin Ho ◽  
Yi-Hsin Chan ◽  
Min-Hsien Wu ◽  
Han-Hwa Hu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Delayed Diagnosis ◽  
Follow Up Study

scholarly journals Treatment of cryptogenicstroke patients with atrial fibrillation detected by insertable cardiac monitors reduces recurrent stroke risk to background levels

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Kloosterman ◽  
M.R Rosenbaum ◽  
E.J.B Berkowitz ◽  
N.K Kloosterman ◽  
J Rosman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulation ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Cryptogenic Stroke ◽  
Stroke Rate ◽  
Stroke Patients ◽  
Background Levels ◽  
Significant Difference ◽  
Recurrent Strokes

Abstract Background Atrial fibrillation (AF) is a well-known risk factor for ischemic stroke with a reported increased incidence range of 2.5 to 5-fold. However, it is not well established whether treatment of cryptogenic stroke patients with AF detected by insertable cardiac monitors (ICM) reduces the risk of recurrent stroke. Objective To compare recurrent stroke rates between cryptogenic stroke patients who have AF detected by ICMs and thus started on oral anticoagulation (OAC) treatment and those without detected AF. Methods We performed a retrospective analysis of consecutive patients who received an ICM for the purpose of AF monitoring following a cryptogenic stroke between July 2015 and March 2019. Patients with prior documented AF history were excluded. We calculated the rates of AF detection and OAC initiation. We also compared recurrent stroke rates between patients with and without AF detected. Results A total of 298 cryptogenic stroke patients receiving an ICM and home remote monitoring were studied (mean age: 77 SD: 11.7; Female/Male: 147 (49%)/151; virtual CHA2DS2-VASc: 4.96 SD: 1.28). AF was newly detected in 91 (29.6%) patients over a mean follow-up of 46 months. Of these patients 68 (72.4%) were started on OAC, 12 (15.3%) were already on OAC and 11 (12.2%) remained not anticoagulated. Of the total patients evaluated, 22 patients (7.3%) developed recurrent strokes for an annualized stroke rate of 1.926%. Of those, 8 occurred among the 91 patients with newly detected AF, for an annualized stroke rate of 1.72%. The remining 14 recurrent strokes occurred among the 207 patients without AF detected, for an annualized stroke rate of 1.76%; (p=0.87). One recurrent stroke occurred in an AF patient not anticoagulated due to a prior bleeding event. No hemorrhagic strokes were reported in the AF-OAC group. Conclusion Our study found that newly AF was detected by ICM in almost 1/3 (29%) of cryptogenic stroke patients (consistent with previous studies), and the vast majority of them (88%) accordingly received oral anticoagulation. There was not a significant difference in recurrent stroke rates among patients with AF detected on OAC and those without AF detected. This suggests that rigorous arrhythmia monitoring with ICMs can help identify cryptogenic stroke patients with new AF and initiate oral anticoagulation accordingly, to reduce their risk of recurrent stroke to background levels. Annualized Stroke Risk Funding Acknowledgement Type of funding source: None

Optimizing Heart Rate and Controlling Symptoms in Atrial Fibrillation

2016 ◽  
Vol 10 (1) ◽  
pp. 26
Author(s):  
Pragnesh Parikh ◽  
◽  
KL Venkatachalam ◽  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Rate Control ◽  
Stroke Risk ◽  
Symptom Control ◽  
Review Article ◽  
Rhythm Control ◽  
Ventricular Rate ◽  
Control Methods ◽  
Novel Approaches

Atrial fibrillation (AF) is the most common arrhythmia noted in clinical practice and its incidence and prevalence are on the rise. The single most important intervention is the evaluation and treatment of stroke risk. Once the risk for stroke has been minimized, controlling the ventricular rate and treating symptoms become relevant. In this review article, we emphasize the importance of confirming and treating the appropriate arrhythmia and correlating symptoms with rhythm changes. Furthermore, we evaluate some of the risk factors for AF that independently result in symptoms, underlining the need to treat these risk factors as part of symptom control. We then discuss existing and novel approaches to rate control in AF and briefly cover rhythm control methods.

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