Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishiku, Kitakyushu 807-8555, Japan.
Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishiku, Kitakyushu 807-8555, Japan.
Clin Neurol Neurosurg. 2023 Dec;235:108042. doi: 10.1016/j.clineuro.2023.108042. Epub 2023 Nov 2.
In this study, we aimed to examine the association between atrial fibrillation and mortality after ischemic stroke and evaluate the use of anticoagulation therapy for atrial fibrillation before stroke onset in patients who experienced stroke.
In this retrospective observational study, we used a combined database of medical and long-term care insurance claims data from one prefecture in Japan. The data of 25,352 patients aged ≥ 65 years who were hospitalized in acute care hospitals with a diagnosis of ischemic stroke between April 2012 and March 2015 were extracted. Cox proportional hazard modeling, with adjustment for age, sex, comorbidities, and long-term care dependency level (based on the activities of daily living), was performed to evaluate the relationship between mortality and atrial fibrillation.
The prevalence of atrial fibrillation was 21.8% in the study population. A significant association was noted between mortality and atrial fibrillation (adjusted hazard ratio: 1.28, 95% confidence interval: 1.16-1.41, p < 0.001). Anticoagulant drugs were used in 32.2% of the patients with atrial fibrillation.
These results indicate that atrial fibrillation is associated with mortality after stroke; however, the use of anticoagulation therapy for atrial fibrillation is unsatisfactory. Efforts to improve the use of atrial fibrillation therapy are required in Japan.
本研究旨在探讨心房颤动与缺血性卒死后死亡率之间的关系，并评估在发生卒中的患者中，卒中发病前使用抗凝治疗心房颤动的情况。
本回顾性观察性研究使用了来自日本一个县的医疗和长期护理保险索赔数据的综合数据库。共提取了 2012 年 4 月至 2015 年 3 月期间在急性护理医院因缺血性卒中住院的年龄≥65 岁的 25352 例患者的数据。采用 Cox 比例风险模型，对年龄、性别、合并症和长期护理依赖程度（基于日常生活活动能力）进行调整，以评估死亡率与心房颤动之间的关系。
在研究人群中，心房颤动的患病率为 21.8%。死亡率与心房颤动显著相关（调整后的危险比：1.28，95%置信区间：1.16-1.41，p<0.001）。心房颤动患者中有 32.2%使用了抗凝药物。
这些结果表明，心房颤动与卒中后死亡率相关；然而，心房颤动的抗凝治疗使用率并不理想。日本需要努力改善心房颤动治疗的使用情况。
