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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Anticoagulation and population risk of stroke and death in incident atrial fibrillation: a population-based cohort
Amy Y X Yu1, Shaun Malo1, Stephen Wilton1
1Department of Clinical Neurosciences (Yu), University of Calgary, Calgary, Alta.; Surveillance and Assessment Branch (Malo, Svenson), Alberta Health, Edmonton, Alta.; Libin Cardiovascular Institute (Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Parkash), Queen Elizabeth II Health Sciences Center, Halifax, NS; School of Public Health (Svenson), University of Alberta, Edmonton, Alta.; Departments of Clinical Neurosciences and Community Health Sciences (Hill), University of Calgary, Calgary, Alta.
Insights
Anticoagulation therapy significantly reduces stroke and death risk in new atrial fibrillation patients. This study supports aggressive screening and treatment for atrial fibrillation to improve outcomes.
Area of Science:
- Cardiology
- Public Health
- Pharmacology
Background:
- Atrial fibrillation (AF) poses a significant risk for stroke and mortality.
- Anticoagulation therapy is proven effective for stroke prevention in AF but is underutilized.
- This study evaluated anticoagulation's effectiveness and safety in new-onset AF patients in Alberta, Canada.
Purpose of the Study:
- To determine the effectiveness of anticoagulation therapy in preventing stroke and death.
- To assess the safety of anticoagulation therapy in patients with new-onset atrial fibrillation.
- To evaluate anticoagulation use in a real-world, population-based setting.
Main Methods:
- Population-based cohort study utilizing administrative health data from Alberta.
- Inclusion of all new-onset atrial fibrillation patients between January 1, 2009, and December 31, 2010.
- Time-to-event analysis and Cox proportional hazards modeling, adjusting for sex and CHADS2 score, to assess anticoagulation's impact on stroke and death.
Main Results:
- Out of 10,745 patients, 68.5% received anticoagulation, primarily warfarin.
- Anticoagulation significantly decreased the risk of ischemic stroke (HR 0.69), all stroke (HR 0.77), and all-cause mortality (HR 0.67).
- An increased risk of hemorrhagic stroke (HR 1.92) was observed, with neutral associations for subdural and gastrointestinal hemorrhage.
Conclusions:
- Anticoagulation therapy is effective and safe for stroke prevention and mortality reduction in incident atrial fibrillation.
- Population data strongly support proactive screening for atrial fibrillation.
- Aggressive treatment with anticoagulant medications is recommended to prevent stroke and death in AF patients.
Background:
Atrial fibrillation increases the risk of stroke and death. Anticoagulation therapy is an effective treatment for stroke prevention, but remains underused in the community. We sought to determine the effectiveness and safety of anticoagulation therapy in an inception cohort with new-onset atrial fibrillation in the province of Alberta, Canada.
Methods:
We conducted a population-based cohort study of atrial fibrillation using an administrative database from Alberta's publicly funded and universally available health care system. All new-onset atrial fibrillation patients from Jan. 1, 2009, to Dec. 31, 2010, were included in the cohort and followed through Dec. 31, 2013. We assessed anticoagulation status as a predictor of stroke and death using time-to-event analysis and adjusted for sex and CHADS2 (congestive heart failure, hypertension, age ≥ 75 yr, diabetes mellitus and prior stroke or transient ischemic attack) score using Cox proportional hazards modelling.
Results:
We identified 10 745 patients, 7358 (68.5%) of whom received anticoagulation therapy, principally with warfarin (n = 6997, 95.1%). Anticoagulation therapy was associated with significantly decreased risk of ischemic stroke (hazard ratio [HR] 0.69, 95% confidence interval [CI] 0.58-0.82), all stroke (HR 0.77, 95% CI 0.65-0.91), all stroke and death (HR 0.70, 95% CI 0.62-0.72) and all-cause mortality (HR 0.67, 95% CI 0.62-0.72), despite an association with increased risk of hemorrhagic stroke (HR 1.92, 95% CI 1.17-3.16). There was a neutral association with subdural (HR 1.01, 95% CI 0.53-1.93) and gastrointestinal (HR 0.96, 95% CI 0.70-1.31) hemorrhage.
Interpretation:
Anticoagulation therapy is effective and safe for stroke prevention and decreases mortality in patients with incident atrial fibrillation. These population data support an aggressive approach to screening for atrial fibrillation and treatment with anticoagulant medicines to prevent stroke and death.
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