This Article Full Text Full Text (PDF) All Versions of this Article: 36/11/2362    most recent 01.STR.0000185927.63746.23v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Miyasaka, Y. Articles by Tsang, T. S.M. Search for Related Content PubMed PubMed Citation Articles by Miyasaka, Y. Articles by Tsang, T. S.M. Related Collections Embolic stroke Anticoagulants

(Stroke. 2005;36:2362.)
© 2005 American Heart Association, Inc.

Original Contributions

Time Trends of Ischemic Stroke Incidence and Mortality in Patients Diagnosed With First Atrial Fibrillation in 1980 to 2000

Report of a Community-Based Study

Yoko Miyasaka, MD, PhD; Marion E. Barnes, MSc; Bernard J. Gersh, MB, ChB, DPhil; Stephen S. Cha, MS; James B. Seward, MD; Kent R. Bailey, PhD; Toshiji Iwasaka, MD, PhD Teresa S.M. Tsang, MD

From the Division of Cardiovascular Disease and Internal Medicine (Y.M., M.E.B., B.J.G., J.B.S., T.S.M.T.) and the Section of Biostatistics (S.S.C., K.R.B.), Mayo Clinic, Rochester, Minn; and the Cardiovascular Division (T.I.), Department of Medicine II, Kansai Medical University, Osaka, Japan.

Correspondence to Teresa S.M. Tsang, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail tsang.teresa{at}mayo.edu

Background and Purpose— With the changes in management of atrial fibrillation (AF) over time, it is possible that the time trends of post-AF stroke incidence and mortality have changed. We sought to determine whether the incidence and survival of ischemic stroke after AF diagnosis have improved.

Methods— We identified the Olmsted County, Minn, residents who developed first AF from 1980 to 2000 and followed them in medical records to 2004. The outcomes were first ischemic stroke and death.

Results— Of the 4117 subjects diagnosed with first AF and without previous stroke, 446 (11%) sustained a first ischemic stroke during a mean follow-up time of 5.5±5.0 years. The age- and sex-adjusted incidence of stroke decreased, on average, by 3.4% per year (P=0.0001), concurrent with an increase in warfarin and aspirin use (both P<0.0001) and reduction of systolic blood pressure (P<0.001). The age-adjusted ischemic stroke incidence was higher in women (P=0.039), but not after adjusting for systolic blood pressure (P=0.41). Compared with the general Minnesota white population, the relative mortality hazard ratio was 1.88 for men and 1.84 for women without stroke and 3.03 for men and 3.80 for women (P<0.05) with stroke. The relative mortality hazard did not vary by age or calendar year of AF diagnosis.

Conclusions— Post-AF ischemic stroke incidence decreased significantly from 1980 to 2000, during which time a substantial increase in the use of antithrombotic therapy and reduction of systolic blood pressure was evident. The relative mortality risk of stroke, however, had not improved over time.

Key Words: atrial fibrillation • incidence • stroke

This article has been cited by other articles:

				M. L. Flaherty, O. Adeoye, P. Sekar, M. Haverbusch, C. J. Moomaw, H. Tao, J. P. Broderick, and D. Woo The Challenge of Designing a Treatment Trial for Warfarin-Associated Intracerebral Hemorrhage Stroke, May 1, 2009; 40(5): 1738 - 1742. [Abstract] [Full Text] [PDF]

				Y. Bejot, D. B. Salem, G. V. Osseby, G. Couvreur, J. Durier, C. Marie, Y. Cottin, T. Moreau, and M. Giroud Epidemiology of ischemic stroke from atrial fibrillation in Dijon, France, from 1985 to 2006 Neurology, January 27, 2009; 72(4): 346 - 353. [Abstract] [Full Text] [PDF]

				D. M. Popping, N. Elia, E. Marret, C. Remy, and M. R. Tramer Protective Effects of Epidural Analgesia on Pulmonary Complications After Abdominal and Thoracic Surgery: A Meta-Analysis Arch Surg, October 1, 2008; 143(10): 990 - 999. [Abstract] [Full Text] [PDF]

				Stroke Risk in Atrial Fibrillation Working Group Comparison of 12 Risk Stratification Schemes to Predict Stroke in Patients With Nonvalvular Atrial Fibrillation Stroke, June 1, 2008; 39(6): 1901 - 1910. [Abstract] [Full Text] [PDF]

				The Stroke Risk in Atrial Fibrillation Working Gro Independent predictors of stroke in patients with atrial fibrillation: A systematic review Neurology, August 7, 2007; 69(6): 546 - 554. [Abstract] [Full Text] [PDF]

				Y. Miyasaka, M. E. Barnes, R. C. Petersen, S. S. Cha, K. R. Bailey, B. J. Gersh, G. Casaclang-Verzosa, W. P. Abhayaratna, J. B. Seward, T. Iwasaka, et al. Risk of dementia in stroke-free patients diagnosed with atrial fibrillation: data from a community-based cohort Eur. Heart J., August 2, 2007; 28(16): 1962 - 1967. [Abstract] [Full Text] [PDF]

				M. L. Flaherty, B. Kissela, D. Woo, D. Kleindorfer, K. Alwell, P. Sekar, C. J. Moomaw, M. Haverbusch, and J. P. Broderick The increasing incidence of anticoagulant-associated intracerebral hemorrhage Neurology, January 9, 2007; 68(2): 116 - 121. [Abstract] [Full Text] [PDF]

				K. Lakshminarayan, C. A. Solid, A. J. Collins, D. C. Anderson, and C. A. Herzog Atrial Fibrillation and Stroke in the General Medicare Population: A 10-Year Perspective (1992 to 2002) Stroke, August 1, 2006; 37(8): 1969 - 1974. [Abstract] [Full Text] [PDF]

				Trends in Post-AFib Ischemic Stroke Journal Watch Cardiology, December 2, 2005; 2005(1202): 3 - 3. [Full Text]