Racial and Urban-Rural Difference in the Frequency of Ischemic Stroke as Initial Manifestation of Atrial Fibrillation

Objective: Atrial fibrillation (AF) may remain undiagnosed until the development of complications. We aimed to examine the epidemiology and racial/ethnic and rural/urban differences in the frequency of newly diagnosed AF manifesting as ischemic stroke in a nationally representative sample of Medicare beneficiaries.Methods: We used a 5% random sample of Medicare claims to identify patients newly diagnosed with AF in 2016. The primary dependent variable was stroke or transient ischemic attack (TIA) in the 7 days prior to the first AF diagnosis, i.e., stroke or TIA as the initial manifestation of AF. We constructed a multivariable logistic regression to quantify the association between race/ethnicity, urban/rural residence, and the primary dependent variable.Results: Among 39,409 patients newly diagnosed with AF (mean age 77 ± 10 years; 58% women; 7.2% Black, 87.8% White, 5.1% others), 2,819 (7.2%) had ischemic stroke or TIA in the 7 days prior to AF diagnosis. Black patients (adjusted OR [95% CI]: 1.21 [1.05, 1.40], vs. White) and urban residents (1.21 [1.08, 1.35], vs. rural) were at increased risk of stroke as the initial manifestation of AF. Racial differences were larger among patients aged ≥75 years, with adjusted ORs of 1.43 (1.19, 1.73) for Black vs. White patients, but non-significant for those aged <75 (P for interaction = 0.03).Conclusion: We observed significant and important differences in the risk of stroke as initial manifestation of AF between White and Black patients and between rural and urban residents. Our results suggest potential disparities in the identification AF across race/ethnicity groups and urban/rural areas.

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Abstract MP48: Racial And Urban-rural Disparities In The Frequency Of Ischemic Stroke As First Manifestation Of Atrial Fibrillation

Circulation ◽

10.1161/circ.143.suppl_1.mp48 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Jingchuan Guo ◽

Nico Gabriel ◽

Jared W Magnani ◽

Utibe Essien ◽

Walid Gellad ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Low Income ◽

Rural Areas ◽

Urban Areas ◽

Newly Diagnosed ◽

Black Patients ◽

Increased Risk ◽

Urban Rural ◽

Age And Sex

Introduction: Atrial fibrillation (AF) may be asymptomatic and remain undiagnosed until the development of complications, which precludes primary prevention efforts. We aimed to quantify racial and rural-urban disparities in the frequency of incident AF presenting with ischemic stroke in a nationally representative sample of Medicare beneficiaries. Hypothesis: Black patients have higher frequency of stroke as the first presentation with AF than White patients. Methods: We used a 5% random sample of Medicare claims data to identify patients newly diagnosed with AF in 2016. The primary outcome was stroke as first AF manifestation, and was defined by inpatient diagnosis of ischemic stroke within 7 days prior to the first AF diagnosis. We computed age- and sex-adjusted proportion of AF diagnosis manifesting as stroke and used multivariable logistic regression to quantify the association of race and urban/rural residence with the outcome, adjusting for demographic and clinical characteristics. Results: Among 39,437 patients newly diagnosed with AF, 2,821 (7.2%) had ischemic stroke as the first AF manifestation. In urban areas, age- and sex-adjusted proportions of AF diagnosis manifesting as stroke were 7.2(95%CI: 6.8,7.4)% for White and 9.5(8.4,10.8)% for Black, compared to 5.9(5.4,6.4)% and 8.1(5.8,11.1)% in rural areas ( Figure ). After adjusting for age, sex, CHA 2 DS 2 -VASc score, Alzheimer's disease, Medicaid enrollment, and receipt of low-income subsidy, Black race (adjusted OR [95%CI]: 1.21 [1.05, 1.40], vs. White) and urban residence (1.16 [1.06, 1.28], vs. rural) were associated with increased risk of stroke as first AF manifestation. Conclusion: We observed uneven distributions in the frequency of stroke as first manifestation of AF between White and Black patients and between rural and urban residents. Further research is needed to evaluate the effectiveness of AF screening efforts in reducing inequities in health outcomes associated with AF.

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Assessment of Atrial Conduction Times in Patients with Newly Diagnosed Parkinson’s Disease

Parkinson s Disease ◽

10.1155/2018/2916905 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Yiğit Çanga ◽

Ayşe Emre ◽

Gülbün Asuman Yüksel ◽

Mehmet Baran Karataş ◽

Nizamettin Selçuk Yelgeç ◽

...

Keyword(s):

Atrial Fibrillation ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Ischemic Stroke ◽

Electromechanical Coupling ◽

P Wave ◽

Volume Index ◽

Newly Diagnosed ◽

Increased Risk ◽

Atrial Conduction Times

Background. An increased risk of ischemic stroke has been reported in patients with Parkinson’s disease (PD). Atrial fibrillation (AF) is strongly associated with ischemic stroke. Prolonged atrial electromechanical delay (EMD) is an independent predictor for the development of AF. Aims. The aim of the present study was to evaluate the atrial conduction parameters in patients with PD and to assess their relation with the severity of PD. Study design. We prospectively enrolled 51 consecutive patients with newly diagnosed PD and 31 age- and sex-matched non-PD subjects. Methods. To assess atrial electromechanical coupling (PA), the time intervals from the onset of p wave on ECG to the late diastolic wave at the septal (PAs) and lateral (PAl) mitral annulus and lateral tricuspid annulus (PAt) were measured on Tissue Doppler Echocardiography (TDE). The difference between PAs-PAl, PAs-PAt, and PAl-PAt were defined as left intra-atrial, right intra-atrial, and interatrial EMD, respectively. P-wave dispersion (PWD) was calculated from the 12-lead ECG. Results. PWD, PAs, PAl, and PAt durations were significantly prolonged in the PD group (all p<0.001). Interatrial, right, and left intra-atrial EMD were also significantly longer in PD patients (p<0.001, p<0.001 and p=0.002, resp.). There were significant positive correlations between disease severity (UPDRS score) and PWD (r=0.34, p=0.041), left intra-atrial (r=0.39, p=0.005), and interatrial EMD (r=0.35, p=0.012). By multivariate analysis, PWD (OR: 1.13, 95% CI: 1.02–1.25; p=0.017), LA volume index (OR: 1.19, 95% CI: 1.02–1.37; p=0.021), left intra-atrial (OR: 1.12, 95% CI: 1.01–1.24; p=0.041), and interatrial EMD (OR: 1.08, 95% CI: 1.01–1.16; p=0.026) were found as independent predictors of PD. Conclusion. Atrial conduction times were longer and correlated with the severity of disease in PD patients. Prolonged inter- and intra-atrial-EMD intervals were also found as independent correlates of PD. These findings may suggest an increased predisposition to atrial fibrillation in PD.

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Abstract MP75: Geographic Variation in Stroke Rates and Oral Anticoagulation Use among Medicare Beneficiaries with Atrial Fibrillation

Circulation ◽

10.1161/circ.137.suppl_1.mp75 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Inmaculada Hernandez ◽

Samir Saba ◽

Yuting Zhang

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Geographic Variation ◽

Newly Diagnosed ◽

Medicare Beneficiaries ◽

The West ◽

North Central ◽

Census Division ◽

Adjusted Rate ◽

West North Central

Background: Recent studies have shown strong geographic variation in oral anticoagulation (OAC) use in atrial fibrillation (AF); however, it remains unknown how this contributes to the geographic variation in ischemic stroke observed across the US. The objective of the present study was to evaluate the relationship between the geographic variation in the initiation of OAC and the incidence of ischemic stroke in a cohort of Medicare beneficiaries newly diagnosed with AF. Methods: Using 2013-2014 claims data from a 5% random sample of Medicare beneficiaries, we identified patients newly diagnosed with AF in 2013-2014 and categorized them according to their initiation of OAC. Our sample included 21,226 OAC initiators and 20,068 patients who did not initiate OAC therapy. We assigned each patient to one of the 9 US Census Divisions using the zip code, and collected their medical claims with a diagnosis of ischemic stroke. We constructed logistic regression models to estimate the average adjusted probability of OAC initiation and Poisson models to estimate the average adjusted rate of ischemic stroke, in each Census Division. Both estimates were adjusted for demographics, eligibility for Medicaid coverage and for low-income subsidy, enrollment in a Medicare Advantage Part D plan, and a comprehensive list of clinical characteristics. We computed the correlation between the average adjusted probability of OAC initiation and the average adjusted rate of ischemic stroke at the Census Division level. Results: The probability of OAC initiation was lowest in the West South Central (0.47) and highest in the West North Central (0.54) and New England (0.54). The average adjusted rate of ischemic stroke was lowest in the West North Central (0.09) and highest in the South Atlantic (0.14) and South West Central (0.14). The average adjusted probability of OAC initiation at the Census Division level and the average adjusted rate of ischemic stroke were inversely correlated, with R=-0.576, p-value=0.10. This suggests that variation in OAC initiation likely explains at least a third of geographic variation in ischemic stroke [R 2 =(-0.576) 2 =0.332]. Conclusions: Our results suggest that geographic variations in OAC initiation within the U.S. explain, in part, variations in the incidence of ischemic stroke among AF patients. Further mechanistic research using advanced causal mediation models is warranted.

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Premature Ventricular Complexes on Screening Electrocardiogram and Risk of Ischemic Stroke

Stroke ◽

10.1161/strokeaha.114.008447 ◽

2015 ◽

Vol 46 (5) ◽

pp. 1365-1367 ◽

Cited By ~ 7

Author(s):

Sunil K. Agarwal ◽

Jennifer Chao ◽

Frederick Peace ◽

Suzanne E. Judd ◽

Brett Kissela ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Racial Differences ◽

Proportional Hazards Model ◽

Geographic Region ◽

Left Ventricular ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Premature Ventricular Complexes ◽

Increased Risk

Background and Purpose— Premature ventricular complexes (PVCs) detected from long-term ECG recordings have been associated with an increased risk of ischemic stroke. Whether PVCs seen on routine ECG, commonly used in clinical practice, are associated with an increased risk of ischemic stroke remains unstudied. Methods— This analysis included 24 460 participants (aged, 64.5+9.3 years; 55.1% women; 40.0% blacks) from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who were free of stroke at the time of enrollment. PVCs were ascertained from baseline ECG (2003–2007), and incident stroke cases through 2011 were confirmed by an adjudication committee. Results— A total of 1415 (5.8%) participants had at least 1 PVC at baseline, and 591 developed incident ischemic stroke during an average (SD) follow-up of 6.0 (2.0) years. In a cox proportional hazards model adjusted for age, sex, race, geographic region, education, previous heart disease, systolic blood pressure, blood pressure–lowering medications, current smoking, diabetes mellitus, left ventricular hypertrophy by ECG, and aspirin use and warfarin use, the presence of PVCs was associated with 38% increased risk of ischemic stroke (hazard ratio [95% confidence interval], 1.38 [1.05–1.81]). Conclusions— PVCs are common on routine screening ECGs and are associated with an increased risk of ischemic stroke.

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Acute cardiovascular events and all-cause mortality in patients with hyperthyroidism: a population-based cohort study

Acta Endocrinologica ◽

10.1530/eje-16-0576 ◽

2017 ◽

Vol 176 (1) ◽

pp. 1-9 ◽

Cited By ~ 19

Author(s):

Olaf M Dekkers ◽

Erzsébet Horváth-Puhó ◽

Suzanne C Cannegieter ◽

Jan P Vandenbroucke ◽

Henrik Toft Sørensen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Ischemic Stroke ◽

Cardiovascular Events ◽

Population Based ◽

Arterial Embolism ◽

Registration System ◽

Increased Risk ◽

All Cause Mortality

Objective Several studies have shown an increased risk for cardiovascular disease (CVD) in hyperthyroidism, but most studies have been too small to address the effect of hyperthyroidism on individual cardiovascular endpoints. Our main aim was to assess the association among hyperthyroidism, acute cardiovascular events and mortality. Design It is a nationwide population-based cohort study. Data were obtained from the Danish Civil Registration System and the Danish National Patient Registry, which covers all Danish hospitals. We compared the rate of all-cause mortality as well as venous thromboembolism (VTE), acute myocardial infarction (AMI), ischemic and non-ischemic stroke, arterial embolism, atrial fibrillation (AF) and percutaneous coronary intervention (PCI) in the two cohorts. Hazard ratios (HR) with 95% confidence intervals (95% CI) were estimated. Results The study included 85 856 hyperthyroid patients and 847 057 matched population-based controls. Mean follow-up time was 9.2 years. The HR for mortality was highest in the first 3 months after diagnosis of hyperthyroidism: 4.62, 95% CI: 4.40–4.85, and remained elevated during long-term follow-up (>3 years) (HR: 1.35, 95% CI: 1.33–1.37). The risk for all examined cardiovascular events was increased, with the highest risk in the first 3 months after hyperthyroidism diagnosis. The 3-month post-diagnosis risk was highest for atrial fibrillation (HR: 7.32, 95% CI: 6.58–8.14) and arterial embolism (HR: 6.08, 95% CI: 4.30–8.61), but the risks of VTE, AMI, ischemic and non-ischemic stroke and PCI were increased also 2- to 3-fold. Conclusions We found an increased risk for all-cause mortality and acute cardiovascular events in patients with hyperthyroidism.

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Clustering of healthy lifestyle behaviors is associated with a lower incidence of adverse events in patients with newly diagnosed atrial fibrillation: a nationwide cohort study

European Heart Journal ◽

10.1093/eurheartj/ehab724.0336 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S R Lee ◽

E K Choi ◽

K D Han ◽

S Oh ◽

G Y H Lip

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ischemic Stroke ◽

Adverse Events ◽

Healthy Lifestyle ◽

Health Screening ◽

Major Adverse Cardiovascular Events ◽

Lifestyle Behaviors ◽

Newly Diagnosed ◽

Healthy Lifestyle Behaviors

Abstract Background Although unhealthy or healthy lifestyle behaviors tend to be clustered, studies on the risk of clinical outcomes depending on how the lifestyle behaviors are managed after atrial fibrillation (AF) diagnosis remain limited. Purpose We aimed to evaluate the association between a cluster of healthy lifestyle behaviors and the risk of adverse outcomes in patients with AF. Methods Using the Korean National Insurance Service database, patients who were newly diagnosed as nonvalvular AF between 2009 and 2016 and received national health screening examination within 2-year after AF diagnosis were included. A healthy lifestyle behavior score (HLS) was calculated by assigning 1 point each for “non-current” smoking, for non-drinking, and for performing regular exercise from the self-reported questionnaire in health screening examinations. The primary outcome was defined as major adverse cardiovascular events (MACE), including ischemic stroke, myocardial infarction, and hospitalization for heart failure. The secondary outcomes included individual components of the primary composite outcome and all-cause death. Results A total of 208,662 patients were included and 7.1%, 22.7%, 58.6%, and 11.6% were HLS 0, 1, 2, and 3 group, respectively. After multivariable adjustment, patients with HLS 1, 2, and 3 were associated with lower risks of MACE compared to those with HLS 0 (adjusted hazard ratio [95% confidence interval]: 0.788 [0.762–0.855], 0.654 [0.604–0.708], and 0.579 [0.527–0.636], respectively) (Figure). Increased number of healthy lifestyle behaviors were associated with lower risks of ischemic stroke, hospitalization for heart failure, and all-cause death. The risk reduction of healthy lifestyle combinations was consistently observed in various subgroups, regardless of CHA2DS2-VASc score and oral anticoagulant use. Conclusion Increased number of healthy lifestyle behaviors were significantly associated with lower MACE and all-cause death risks in patients with new-onset AF. These findings support the promotion of a healthy lifestyle to reduce the risk of adverse events in AF patients. FUNDunding Acknowledgement Type of funding sources: None.

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Analysis of Influencing Factors of Compliance with Non-Vitamin K Antagonist Oral Anticoagulant in Patients with Nonvalvular Atrial Fibrillation and Correlation with the Severity of Ischemic Stroke

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2021/1021127 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Li Zhu ◽

Xiaodan Zhang ◽

Jing Yang

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Influencing Factors ◽

Clinical Supervision ◽

Vitamin K ◽

Pearson Correlation ◽

Anticoagulation Therapy ◽

Vitamin K Antagonist ◽

Nonvalvular Atrial Fibrillation ◽

Increased Risk

Nonvalvular atrial fibrillation (NVAF) is associated with an increased risk of stroke and thrombus, and anticoagulant therapy is a key link in the prevention of stroke. At present, the anticoagulation rate of atrial fibrillation in China is low, and there are many factors affecting the adherence of patients with atrial fibrillation to anticoagulation. Non-vitamin K antagonist oral anticoagulants (NOACs) are anticoagulant with high application value due to their high safety and low risk of intracranial hemorrhage, stroke, and death. However, the compliance of NOACs is poor, and the current situation of anticoagulants in China is not optimistic. In this study, a total of 156 patients with NVAF who received NOAC anticoagulation therapy in our hospital from January 2018 to January 2019 were retrospectively analyzed. The results showed that education background, place of residence, number of complications, CHA2DS2-VASc score, and HAS-BLED score were independent influencing factors for NOACS compliance of NVAF patients. Also, the Pearson correlation analysis showed that there was a negative correlation (r = −0.465, P < 0.001 ) between NOAC compliance and severity of ischemic stroke in patients with NVAF. Therefore, clinical supervision and management of patients with NVAF after NOACs should be strengthened to improve the compliance of patients with NVAF after NOACs, reduce the damage of ischemic stroke, and improve their prognosis.

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Abstract P12: Alteplase Reduces Mortality in Patients With Ischemic Stroke and Atrial Fibrillation: Analysis of the IAC Study

Stroke ◽

10.1161/str.52.suppl_1.p12 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Shadi Yaghi ◽

Eva Mistry ◽

Adam H De Havenon ◽

Christopher Leon Guerrero ◽

Amre Nouh ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Infarct Volume ◽

Intravenous Thrombolysis ◽

The United States ◽

Hemorrhagic Transformation ◽

Stroke Patients ◽

Increased Risk ◽

Significant Difference

Background and Purpose: Multiple studies have established that intravenous thrombolysis with alteplase improves outcome after acute ischemic stroke. However, assessment of thrombolysis’ efficacy in stroke patients with atrial fibrillation (AF) has yielded mixed results. We sought to determine the association of alteplase with mortality, hemorrhagic transformation (HT), infarct volume, and mortality in patients with AF and acute ischemic stroke. Methods: We retrospectively analyzed consecutive acute ischemic stroke patients with AF included in the Initiation of Anticoagulation after Cardioembolic stroke (IAC) study, which pooled data from 8 comprehensive stroke centers in the United States. 1889 (90.6%) had available 90-day follow up data and were included. For our primary analysis we used a cohort of 1367/1889 (72.4%) patients who did not undergo mechanical thrombectomy (MT). Secondary analyses were repeated in the patients that underwent MT (n=522). Binary logistic regression was used to determine whether alteplase use was independently associated with risk of HT, final infarct volume, and 90-day mortality, respectively, adjusting for potential confounders. Results: In our primary analyses we found that alteplase use was independently associated with an increased risk for HT (adjusted OR 2.14, 95% CI 1.49 - 3.07, p <0.001) but overall reduced risk of 90-day mortality (adjusted OR 0.58, 95% CI 0.39 - 0.87, p = 0.009). Among patients undergoing MT, alteplase use was associated with a trend towards a reduction in 90-day mortality (adjusted OR 0.68 95% CI 0.45 - 1.04, p = 0.077). In the subgroup of patients prescribed DOAC treatment (n = 327; 24 received alteplase), alteplase treatment was associated with a trend towards smaller infarct size (< 10 mL), (adjusted OR 0.40, 95% CI 0.15 - 1.12, p = 0.082) without a significant difference in the odds of 90-day mortality (adjusted OR 0.51, 95% CI 0.12 - 2.13, p = 0.357) or hemorrhagic transformation (adjusted OR 0.27, 95% CI 0.03 - 2.07, p = 0.206). Conclusion: Thrombolysis with intravenous alteplase was associated with reduced 90-day mortality in AF patients with acute ischemic stroke not undergoing MT. Further study is required to assess the safety and efficacy of alteplase in AF patients undergoing MT and those on DOACs.

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Abstract 2646: Aortic Arch Plaques and Risk of Vascular Events in Subjects Without Prior Stroke

Circulation ◽

10.1161/circ.118.suppl_18.s_760 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Cesare Russo ◽

Zhezhen Jin ◽

Ralph L Sacco ◽

Shunichi Homma ◽

Tatjana Rundek ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Aortic Arch ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Study Cohort ◽

Vascular Events ◽

Increased Risk ◽

Prior Stroke

BACKGROUND: Aortic arch plaques (AAP) are a risk factor for cardiovascular embolic events. However, the risk of vascular events associated with AAP in the general population is unclear. AIM: To assess whether AAP detected by transesophageal echocardiography (TEE) are associated with an increased risk of vascular events in a stroke-free cohort. METHODS: The study cohort consisted of stroke-free subjects over age 50 from the Aortic Plaques and Risk of Ischemic Stroke (APRIS) study. AAP were assessed by multiplane TEE, and considered large if ≥ 4 mm in thickness. Vascular events including myocardial infarction, ischemic stroke and vascular death were recorded during the follow-up. The association between AAP and outcomes was assessed by univariate and multivariate Cox proportional hazards models. RESULTS: A group of 209 subjects was studied (mean age 67±9 years; 45% women; 14% whites, 30% blacks, 56% Hispanics). AAP of any size were present in 130 subjects (62%); large AAP in 50 (24%). Subjects with AAP were older (69±8 vs. 63±7 years), had higher systolic BP (146±21 vs.139±20 mmHg), were more often white (19% vs. 8%), smokers (20% vs. 9%) and more frequently had a history of coronary artery disease (26% vs. 14%) than those without AAP (all p<0.05). Lipid parameters, prevalence of atrial fibrillation and diabetes mellitus were not significantly different between the two groups. During the follow up (94±29 months) 30 events occurred (13 myocardial infarctions, 11 ischemic strokes, 6 vascular deaths). After adjustment for other risk factors, AAP of any size were not associated with an increased risk of combined vascular events (HR 1.07, 95% CI 0.44 to 2.56). The same result was observed for large AAP (HR 0.94, CI 0.34 to 2.64). Age (HR 1.05, CI 1.01 to 1.10), body mass index (HR 1.08, CI 1.01 to 1.15) and atrial fibrillation (HR 3.52, CI 1.07 to 11.61) showed independent association with vascular events. In a sub-analysis with ischemic stroke as outcome, neither AAP of any size nor large AAP were associated with an increased risk. CONCLUSIONS: In this cohort without prior stroke, the incidental detection of AAP was not associated with an increased risk of future vascular events. Associated co-factors may affect the AAP-related risk of vascular events reported in previous studies.

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

Stroke ◽

10.1161/str.48.suppl_1.tmp100 ◽

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).

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