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https://hdl.handle.net/2440/131338
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Type: | Journal article |
Title: | A meta-analysis of clinical risk factors for stroke in anticoagulant-naïve patients with atrial fibrillation |
Author: | Noubiap, J.J. Feteh, V.F. Middeldorp, M.E. Fitzgerald, J.L. Thomas, G. Kleinig, T. Lau, D.H. Sanders, P. |
Citation: | Europace, 2021; 23(10):1528-1538 |
Publisher: | Oxford University Press |
Issue Date: | 2021 |
ISSN: | 1099-5129 1532-2092 |
Statement of Responsibility: | Jean Jacques Noubiap, Vitalis Fambombi Feteh, Melissa E Middeldorp, John L Fitzgerald, Gijo Thomas, Timothy Kleinig ... et al. |
Abstract: | Aims The aim of this study is to summarize data from prospective cohort studies on clinical predictors of stroke and systemic embolism in anticoagulant-naïve atrial fibrillation (AF) patients. Methods and results EMBASE, MEDLINE, Global Index Medicus, and Web of Science were searched to identify all studies published by 28 November 2019. Forty-seven studies reporting data from 1 756 984 participants in 15 countries were included. The pooled incidence of stroke in anticoagulant-naïve AF patients was 23.8 per 1000 person-years (95% CI 19.7-28.2). Older age was associated with incident stroke or systemic embolism, with a pooled hazard ratio (HR) of 2.14 (95% CI 1.85-2.47), 2.83 (95% CI 2.27-3.51), and 6.87 (95% CI 6.33-7.44) for age 65-75, ≥75, and ≥85 years, respectively. Other predictors of stroke or systemic embolism included history of stroke or TIA (HR 2.84, 95% CI 2.19-3.67), hypertension (HR 1.60, 95% CI 1.37-1.86), diabetes (HR 1.28, 95% CI 1.20-1.37), heart failure (HR 1.25, 95% CI 1.11-1.40), peripheral artery disease (pooled HR 1.35, 95% CI 1.04-1.75), vascular disease (pooled HR 1.21, 95% CI 1.06-1.39), and prior myocardial infarction (pooled HR 1.08, 95% CI 1.03-1.14). Female sex was a predictor of thromboembolism in studies outside Asia (HR 1.33, 95% CI 1.15-1.55), but not in those done in Asia (HR 0.95, 95% CI 0.81-1.10). ConclusionThis study confirms age and prior stroke as the strongest predictors of stroke or systemic embolism in anticoagulant-naive AF patients. Other predictors include hypertension, diabetes, heart failure, and vascular disease. Female sex seems not to be universally associated with stroke or systemic embolism. |
Keywords: | Antocoagilant-naive Atrial fibrillation Diabetes Female Hear failure Hypertension Meta-analysis Risk factor Stroke |
Description: | Online publish-ahead-of-print 19 July 2021 |
Rights: | Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. |
DOI: | 10.1093/europace/euab087 |
Grant ID: | NHMRC |
Published version: | http://dx.doi.org/10.1093/europace/euab087 |
Appears in Collections: | Aurora harvest 4 Medicine publications |
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