Age Threshold for Increased Stroke Risk Among Patients With Atrial Fibrillation: A Nationwide Cohort Study From Taiwan

Recent studies from Asia have suggested that the risk of ischemic stroke for patients with atrial fibrillation (AF) with a "low-risk" congestive heart failure, hypertension, age ≥75, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65 to 74, female (CHA2D...

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Published in:Journal of the American College of Cardiology 2015-09, Vol.66 (12), p.1339-1347
Main Authors: Chao, Tze-Fan, Wang, Kang-Ling, Liu, Chia-Jen, Lin, Yenn-Jiang, Chang, Shih-Lin, Lo, Li-Wei, Hu, Yu-Feng, Tuan, Ta-Chuan, Chung, Fa-Po, Liao, Jo-Nan, Chen, Tzeng-Ji, Chiang, Chern-En, Lip, Gregory Y H, Chen, Shih-Ann
Format: Article
Language:English
Subjects:
Adult
Age Factors
Anticoagulants - therapeutic use
Atrial Fibrillation - complications
Cohort Studies
Female
Humans
Male
Middle Aged
Risk Assessment
Stroke - epidemiology
Stroke - etiology
Stroke - prevention & control
Taiwan - epidemiology
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Summary:Recent studies from Asia have suggested that the risk of ischemic stroke for patients with atrial fibrillation (AF) with a "low-risk" congestive heart failure, hypertension, age ≥75, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65 to 74, female (CHA2DS2-VASc) score of 0 (for males) or 1 (for females) might be higher than that for non-Asians. This study hypothesized that the age threshold (65 years) used in the CHA2DS2-VASc system for initiating oral anticoagulants (OACs) might be lower in Taiwanese AF patients than in non-Asians. We used the National Health Insurance Research Database in Taiwan to study 186,570 nonanticoagulated AF patients. There were 9,416 males with a CHA2DS2-VASc score of 0 and 6,390 females with a CHA2DS2-VASc score of 1. Their risk of ischemic stroke was analyzed with stratification on the basis of age. The annual risks of ischemic stroke for males (score 0) and females (score 1) were 1.15% and 1.12%, respectively, and continuously increased from younger to older age groups, with an increment in stroke risk evident for patients >50 years of age. At a cutoff of 50 years, patients could be further stratified into 2 subgroups with different stroke risks (>50 years of age: 1.78%/year; vs.
ISSN:1558-3597
DOI:10.1016/j.jacc.2015.07.026