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Published on: February 26, 2013
Independent predictors of stroke in patients with atrial fibrillation: a systematic review
Insights
Patients with atrial fibrillation have varying stroke risks. Key factors like prior stroke, age, hypertension, and diabetes significantly increase stroke risk, aiding personalized prophylaxis decisions.
Area of Science:
- Cardiology
- Neurology
- Epidemiology
Background:
- Nonvalvular atrial fibrillation (AF) presents variable stroke risks.
- Accurate stroke risk stratification is crucial for balancing antithrombotic prophylaxis benefits and risks.
Purpose of the Study:
- To identify consistent independent risk factors for stroke in AF patients.
- To estimate absolute stroke rates associated with identified risk factors.
Main Methods:
- Systematic review of studies employing multivariate regression.
- Analysis of independent stroke risk factors in AF populations.
- Calculation of summary estimates for relative risk using maximum likelihood methods.
Main Results:
- Prior stroke/TIA, increasing age, hypertension, and diabetes mellitus are key independent risk factors.
- Prior stroke/TIA confers the highest risk (approx. 10% per year).
- Other factors like hypertension and diabetes show moderate increases in annual stroke rates.
Conclusions:
- Four clinical features consistently predict stroke risk in AF.
- Prior stroke/TIA is the most significant predictor.
- Precise estimation of absolute stroke rates for individual risk factors requires further data.
Background:
Absolute stroke rates vary widely among patients with nonvalvular atrial fibrillation. To balance the benefits and risks of chronic antithrombotic prophylaxis, it is important to estimate the absolute risk of stroke for individual patients.
Methods:
Systematic review of studies using multivariate regression techniques to identify independent risk factors for stroke in patients with atrial fibrillation was conducted, and reports of absolute stroke rates in subgroups of patients with these risk factors collected. A summary estimate of the relative risk associated with each independent risk factor was calculated using maximum likelihood methods.
Results:
Seven studies (including six entirely independent cohorts) were identified. Prior stroke/TIA (relative risk 2.5, 95% CI 1.8 to 3.5), increasing age (relative risk 1.5 per decade, 95% CI 1.3 to 1.7), a history of hypertension (relative risk 2.0, 95% CI 1.6 to 2.5), and diabetes mellitus (relative risk 1.7, 95% CI 1.4 to 2.0) were the strongest, most consistent independent risk factors. Observed absolute stroke rates for nonanticoagulated patients with single independent risk factors were in the range of 6 to 9% per year for prior stroke/TIA, 1.5 to 3% per year for history of hypertension, 1.5 to 3% per year for age >75, and 2.0 to 3.5% per year for diabetes. Female sex was inconsistently associated with stroke risk, whereas the evidence was inconclusive that either heart failure or coronary artery disease is independently predictive of stroke.
Conclusions:
Four clinical features (prior stroke/TIA, advancing age, hypertension, diabetes) are consistent independent risk factors for stroke in atrial fibrillation patients. Prior stroke/TIA is the most powerful risk factor and reliably confers a high stroke risk (>5% per year, averaging 10% per year). Absolute stroke rates associated with other individual risk factors are difficult to precisely estimate from available data.
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