Chamberlain Alanna M, Brown Robert D, Alonso Alvaro, Gersh Bernard J, Killian Jill M, Weston Susan A, Roger Véronique L
Department of Health Sciences Research, Mayo Clinic, Rochester, MN
Department of Neurology, Mayo Clinic, Rochester, MN.
J Am Heart Assoc. 2016 Jun 13;5(6):e003408. doi: 10.1161/JAHA.116.003408.
While atrial fibrillation is a recognized risk factor for stroke, contemporary data on trends in stroke incidence after the diagnosis of atrial fibrillation are scarce.
Olmsted County, MN residents with incident atrial fibrillation or atrial flutter (collectively referred to as AF) from 2000 to 2010 were identified. Cox regression determined associations of year of AF diagnosis with ischemic stroke and transient ischemic attack (TIA) occurring through 2013. Among 3247 AF patients, 321 (10%) had an ischemic stroke/TIA over a mean of 4.6 years (incidence rate [95% CI] per 100 person-years: 2.14 [1.91-2.38]). Two hundred thirty-nine (7%) of 3265 AF patients experienced an ischemic stroke (incidence rate: 1.54 [1.35-1.75]). The risk of both outcomes remained unchanged over time after adjusting for demographics and comorbidities (hazard ratio [95% CI] per year of AF diagnosis: 1.00 [0.96-1.04] for ischemic stroke/TIA; 1.01 [0.96-1.06] for ischemic stroke only). In analyses restricted to patients with prescription information, the rates of anticoagulation use did not change over time, reaching 50.8% at 1 year after AF diagnosis. Further adjustment for anticoagulation use did not alter the temporal trends in stroke incidence (hazard ratio [95% CI] per year of AF diagnosis: 1.06 [0.97-1.15] for ischemic stroke/TIA; 1.08 [0.98-1.20] for ischemic stroke only).
Strokes/TIAs are frequent after AF, occurring in 10% of patients after 5 years of follow-up. The occurrence of stroke/TIA did not decline over the last decade, which may be influenced by a leveling off of anticoagulation use. This concerning trend has major public health implications.
虽然心房颤动是公认的中风危险因素，但关于心房颤动诊断后中风发病率趋势的当代数据却很匮乏。
确定了2000年至2010年明尼苏达州奥尔姆斯特德县发生心房颤动或心房扑动（统称为房颤）的居民。Cox回归分析确定了房颤诊断年份与截至2013年发生的缺血性中风和短暂性脑缺血发作（TIA）之间的关联。在3247例房颤患者中，321例（10%）在平均4.6年的时间里发生了缺血性中风/TIA（每100人年的发病率[95%CI]：2.14[1.91 - 2.38]）。3265例房颤患者中有239例（7%）发生了缺血性中风（发病率：1.54[1.35 - 1.75]）。在对人口统计学和合并症进行调整后，两种结局的风险随时间保持不变（房颤诊断年份的风险比[95%CI]：缺血性中风/TIA为1.00[0.96 - 1.04]；仅缺血性中风为1.01[0.96 - 1.06]）。在仅限于有处方信息的患者的分析中，抗凝药物的使用率随时间没有变化，在房颤诊断后1年时达到50.8%。进一步对抗凝药物使用情况进行调整并没有改变中风发病率的时间趋势（房颤诊断年份的风险比[95%CI]：缺血性中风/TIA为1.06[0.97 - 1.15]；仅缺血性中风为1.08[0.98 - 1.20]）。
房颤后中风/TIA很常见，随访5年后10%的患者会发生。在过去十年中，中风/TIA的发生率没有下降，这可能受到抗凝药物使用趋于平稳的影响。这一令人担忧的趋势对公共卫生具有重大影响。
