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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
biochemistry, genetics and molecular biology
Stroke risk prediction in patients with atrial fibrillation with and without rheumatic heart disease
Cardiovascular Research, Volume 118, No. 1, Year 2022
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Description
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 CHA2DS2-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 CHA2DS2-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 CHA2DS2-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. © 2020 Published on behalf of the European Society of Cardiology. All rights reserved.
Authors & Co-Authors
Benz, Alexander Philipp
Canada, Hamilton
Population Health Research Institute, Ontario
Healey, Jeff S.
Canada, Hamilton
Population Health Research Institute, Ontario
Chin, Ashley
South Africa, Observatory
Groote Schuur Hospital
Commerford, Patrick Joseph
South Africa, Observatory
Groote Schuur Hospital
Marsden, Tamara
Canada, Hamilton
Population Health Research Institute, Ontario
Karthikeyan, Ganesan
India, New Delhi
All India Institute of Medical Sciences, new Delhi
McIntyre, William Finlay
Canada, Hamilton
Population Health Research Institute, Ontario
Wong, Jorge Alfredo
Canada, Hamilton
Population Health Research Institute, Ontario
Damasceno, A. Antonio Moura
Mozambique, Maputo
Universidade Eduardo Mondlane
Hohnloser, Stefan Hans
Germany, Frankfurt am Main
Goethe-universität Frankfurt am Main
Oldgren, Jonas S.
Sweden, Uppsala
Uppsala Clinical Research Center
Wallentin, Lars
Sweden, Uppsala
Uppsala Clinical Research Center
Ezekowitz, Michael D.
United States, Philadelphia
Thomas Jefferson University
Eikelboom, John W.
Canada, Hamilton
Population Health Research Institute, Ontario
Yusuf, Salim N.
Canada, Hamilton
Population Health Research Institute, Ontario
Connolly, Stuart J.
Canada, Hamilton
Population Health Research Institute, Ontario
Statistics
Citations: 6
Authors: 16
Affiliations: 7
Identifiers
Doi:
10.1093/cvr/cvaa344
ISSN:
00086363
Research Areas
Noncommunicable Diseases
Substance Abuse
Study Design
Cohort Study
Case-Control Study
Participants Gender
Female