Hayden Derek T, Hannon Niamh, Callaly Elizabeth, Ní Chróinín Danielle, Horgan Gillian, Kyne Lorraine, Duggan Joseph, Dolan Eamon, O'Rourke Killian, Williams David, Murphy Sean, Kelly Peter J
From the Stroke Department (D.T.H., E.C., D.N.C., G.H., K.O., S.M., P.J.K.), and Geriatrics Department (L.K., J.D.), Neurovascular Unit for Applied Translational Research and Therapeutics, University College Dublin/Dublin Academic Medical Centre, Mater University Hospital, Dublin, Ireland; Stroke Department, Beaumont University Hospital, Dublin, Ireland (D.W.); Stroke Department, Connolly Hospital Blanchardstown, Dublin, Ireland (E.C., E.D.); Department of Neurosciences, Addenbrookes Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom (N.H.); and Stroke Department, Royal College of Surgeons, Dublin, Ireland (D.W., S.M.).
Stroke. 2015 Dec;46(12):3488-93. doi: 10.1161/STROKEAHA.115.011139. Epub 2015 Oct 15.
Demographic trends in atrial fibrillation (AF) incidence may yield a substantial rise in the societal burden of AF-related stroke (AF-stroke). Accurate population-wide outcome data are essential to inform health service planning to improve AF-stroke prevention, and provision of rehabilitation, nursing home, and community supports for AF-stroke survivors.
We investigated rates and determinants of 5-year fatality, stroke recurrence, functional outcomes, and prescribing of secondary prevention medications in AF-stroke in the North Dublin Population Stroke Study. Ascertainment included hot and cold pursuit using multiple overlapping sources. Survival analysis was performed using lifetables and Kaplan-Meier survival curves, and Cox proportional hazard modeling was performed to identify predictors of death and recurrent stroke.
Five hundred sixty-eight patients with new stroke were identified, including 177 (31.2%) AF-stroke. At 5 years, 39.2% (confidence interval, 31.5-46.8) of ischemic AF-stroke patients were alive. Congestive heart failure, hypertension, age <65, 65-74 years, and ≥75 years, diabetes mellitus, prior stroke, transient ischemic attack or thromboembolism, vascular disease and female sex (CHA2DS2-VASc) score (hazard ratio [HR], 1.34; P<0.001), CHADS2 score (HR 1.42, P=0.004), National Institute of Health Stroke Scale (HR, 1.09; P<0.0001), and subtherapeutic international normalized ratio (<2.0) at stroke onset (HR, 3.29; P=0.003) were independently associated with 5-year fatality, whereas warfarin (HR, 0.40; P=0.001) and statin use after index stroke (HR, 0.52; P=0.005) were associated with improved survival. The 5-year recurrence rate after ischemic AF-stroke was 21.5% (confidence interval, 14.5-31.3). Trends toward greater risk of recurrence were observed for persistent AF (HR, 3.09; P=0.07) and CHA2DS2-VASc score (HR, 1.34; P=0.07). Nursing home care was needed for 25.9% of patients.
AF-stroke is associated with considerable long-term morbidity, fatality, stroke recurrence, and nursing home requirement. Adequately resourced national AF strategies to improve AF detection and prevention are needed.
心房颤动（AF）发病率的人口统计学趋势可能导致与AF相关的卒中（AF-卒中）的社会负担大幅上升。准确的全人群结局数据对于为改善AF-卒中预防以及为AF-卒中幸存者提供康复、养老院和社区支持的卫生服务规划至关重要。
在北都柏林人群卒中研究中，我们调查了AF-卒中患者5年死亡率、卒中复发率、功能结局以及二级预防药物处方的发生率和决定因素。通过使用多个重叠来源进行冷热追踪来确定相关情况。使用生命表和Kaplan-Meier生存曲线进行生存分析，并进行Cox比例风险建模以确定死亡和复发性卒中的预测因素。
共识别出568例新发卒中患者，其中177例（31.2%）为AF-卒中。5年后，39.2%（置信区间，31.5 - 46.8）的缺血性AF-卒中患者存活。充血性心力衰竭、高血压、年龄<65岁、65 - 74岁和≥75岁、糖尿病、既往卒中、短暂性脑缺血发作或血栓栓塞、血管疾病以及女性（CHA2DS2-VASc）评分（风险比[HR]，1.34；P<0.001）、CHADS2评分（HR 1.42，P = 0.004）、美国国立卫生研究院卒中量表（HR，1.09；P<0.0001）以及卒中发作时亚治疗性国际标准化比值（<2.0）（HR，3.29；P = 0.003）与5年死亡率独立相关，而华法林（HR，0.40；P = 0.001）和卒中发作后使用他汀类药物（HR，0.52；P = 0.005）与生存率提高相关。缺血性AF-卒中后的5年复发率为21.5%（置信区间，14.5 - 31.3）。持续性AF（HR，3.09；P = 0.07）和CHA2DS2-VASc评分（HR，1.34；P = 0.07）有复发风险增加的趋势。25.9%的患者需要养老院护理。
AF-卒中与相当高的长期发病率、死亡率、卒中复发率以及养老院需求相关。需要有充足资源的国家AF策略来改善AF的检测和预防。
