Incidence of Stroke or Systemic Embolism in Paroxysmal Versus Sustained Atrial Fibrillation: The Fushimi Atrial Fibrillation Registry
BACKGROUND AND PURPOSE—There is controversy on the relationship of the type of atrial fibrillation (AF) to stroke. Although several studies show that patients with paroxysmal AF (PAF) have a stroke risk similar to those with persistent or permanent AF, recent studies suggest that PAF is associated w...
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| Veröffentlicht in: | Stroke (1970) 2015-12, Vol.46 (12), p.3354-3361 |
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| creator | Takabayashi, Kensuke Hamatani, Yasuhiro Yamashita, Yugo Takagi, Daisuke Unoki, Takashi Ishii, Mitsuru Iguchi, Moritake Masunaga, Nobutoyo Ogawa, Hisashi Esato, Masahiro Chun, Yeong-Hwa Tsuji, Hikari Wada, Hiromichi Hasegawa, Koji Abe, Mitsuru Lip, Gregory Y.H Akao, Masaharu |
| description | BACKGROUND AND PURPOSE—There is controversy on the relationship of the type of atrial fibrillation (AF) to stroke. Although several studies show that patients with paroxysmal AF (PAF) have a stroke risk similar to those with persistent or permanent AF, recent studies suggest that PAF is associated with a lower rate of stroke. Limited data on stroke risk associated with PAF are evident in Asian populations.
METHODS—The Registry Study of Atrial Fibrillation Patients in Fushimi-ku (Fushimi AF Registry) is a community-based survey of patients with AF in Fushimi-ku, Kyoto, Japan. Patients were categorized into 2 types of AFPAF or sustained (persistent or permanent) AF. We compared clinical events between PAF (n=1588) and sustained AF (n=1716).
RESULTS—Patients with PAF were younger, had less comorbidities, and received oral anticoagulants (OAC) less commonly. A lower risk of stroke/systemic embolism during follow-up period in the patients with PAF was consistently observed (non-OAC usershazard ratio, 0.45; 95% confidence intervals, 0.27–0.75; P |
| doi_str_mv | 10.1161/STROKEAHA.115.010947 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1736416970</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1736416970</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3714-dbd7fa685024380f38e2f2a7dd4a7a434d29d2c9d3a2e099ddda233b78dc25653</originalsourceid><addsrcrecordid>eNptUU1v1DAQtRAVXQr_ACEfuaT4M465rapdWlGpVXfhajnxhDVN4mI7KvsD-N-42tJeepp5o_fejOYh9IGSU0pr-nmzvbn6tlqeLwuUp4QSLdQrtKCSiUrUrHmNFoRwXTGh9TF6m9IvQgjjjXyDjlktqaBNs0B_L6bOO5g6wKHHmxzDbeki3uxThtF3eDW2YfBpxH7C1zaGP_s02gH_gJjmhDdzytZP4PAyR1_ma99GPww2-zB9wdsd4PWcdn70LxHwDfz0Kcf9O3TU2yHB-8d6gr6vV9uz8-ry6uvF2fKy6riionKtU72tG0mY4A3peQOsZ1Y5J6yyggvHtGOddtwyIFo75yzjvFWN65isJT9Bnw6-dzH8niFlM_rUQTlngjAnQxWvBa21IoUqDtQuhpQi9OYu-tHGvaHEPARgngIoUJpDAEX28XHD3I7gnkT_P_7sex-GXJ54O8z3EM0O7JB3pkREVK1IxQiVlBVUPYwE_wctr5PN</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1736416970</pqid></control><display><type>article</type><title>Incidence of Stroke or Systemic Embolism in Paroxysmal Versus Sustained Atrial Fibrillation: The Fushimi Atrial Fibrillation Registry</title><source>MEDLINE</source><source>American Heart Association Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Journals@Ovid Complete</source><source>Alma/SFX Local Collection</source><creator>Takabayashi, Kensuke ; Hamatani, Yasuhiro ; Yamashita, Yugo ; Takagi, Daisuke ; Unoki, Takashi ; Ishii, Mitsuru ; Iguchi, Moritake ; Masunaga, Nobutoyo ; Ogawa, Hisashi ; Esato, Masahiro ; Chun, Yeong-Hwa ; Tsuji, Hikari ; Wada, Hiromichi ; Hasegawa, Koji ; Abe, Mitsuru ; Lip, Gregory Y.H ; Akao, Masaharu</creator><creatorcontrib>Takabayashi, Kensuke ; Hamatani, Yasuhiro ; Yamashita, Yugo ; Takagi, Daisuke ; Unoki, Takashi ; Ishii, Mitsuru ; Iguchi, Moritake ; Masunaga, Nobutoyo ; Ogawa, Hisashi ; Esato, Masahiro ; Chun, Yeong-Hwa ; Tsuji, Hikari ; Wada, Hiromichi ; Hasegawa, Koji ; Abe, Mitsuru ; Lip, Gregory Y.H ; Akao, Masaharu</creatorcontrib><description>BACKGROUND AND PURPOSE—There is controversy on the relationship of the type of atrial fibrillation (AF) to stroke. Although several studies show that patients with paroxysmal AF (PAF) have a stroke risk similar to those with persistent or permanent AF, recent studies suggest that PAF is associated with a lower rate of stroke. Limited data on stroke risk associated with PAF are evident in Asian populations.
METHODS—The Registry Study of Atrial Fibrillation Patients in Fushimi-ku (Fushimi AF Registry) is a community-based survey of patients with AF in Fushimi-ku, Kyoto, Japan. Patients were categorized into 2 types of AFPAF or sustained (persistent or permanent) AF. We compared clinical events between PAF (n=1588) and sustained AF (n=1716).
RESULTS—Patients with PAF were younger, had less comorbidities, and received oral anticoagulants (OAC) less commonly. A lower risk of stroke/systemic embolism during follow-up period in the patients with PAF was consistently observed (non-OAC usershazard ratio, 0.45; 95% confidence intervals, 0.27–0.75; P<0.01 and OAC usershazard ratio, 0.59; 95% confidence interval, 0.35–0.93; P=0.03). The composite end point of stroke/systemic embolism/all-cause mortality was also lower in PAF, whether among OAC users (hazard ratio, 0.77; 95% confidence interval, 0.59–0.99; P=0.046) or non-OAC users (hazard ratio, 0.59; 95% confidence interval, 0.46–0.75; P<0.01). On multivariate analysis, PAF was an independent predictor of lower stroke/systemic embolism risk.
CONCLUSIONS—In this large cohort of Japanese patients with AF, PAF was independently associated with lower incidence of stroke/systemic embolism than sustained AF. This may aid decision making for anticoagulation, especially in those patients with AF with few stroke risk factors.
CLINICAL TRIAL REGISTRATION—URLhttp://www.umin.ac.jp/ctr/index.htm. Unique identifierUMIN000005834.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/STROKEAHA.115.010947</identifier><identifier>PMID: 26514188</identifier><language>eng</language><publisher>United States: American Heart Association, Inc</publisher><subject>Aged ; Aged, 80 and over ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - epidemiology ; Cohort Studies ; Embolism - diagnosis ; Embolism - epidemiology ; Female ; Humans ; Incidence ; Japan - epidemiology ; Male ; Middle Aged ; Prospective Studies ; Registries ; Risk Factors ; Stroke - diagnosis ; Stroke - epidemiology</subject><ispartof>Stroke (1970), 2015-12, Vol.46 (12), p.3354-3361</ispartof><rights>2015 American Heart Association, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3714-dbd7fa685024380f38e2f2a7dd4a7a434d29d2c9d3a2e099ddda233b78dc25653</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,3676,27907,27908</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26514188$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Takabayashi, Kensuke</creatorcontrib><creatorcontrib>Hamatani, Yasuhiro</creatorcontrib><creatorcontrib>Yamashita, Yugo</creatorcontrib><creatorcontrib>Takagi, Daisuke</creatorcontrib><creatorcontrib>Unoki, Takashi</creatorcontrib><creatorcontrib>Ishii, Mitsuru</creatorcontrib><creatorcontrib>Iguchi, Moritake</creatorcontrib><creatorcontrib>Masunaga, Nobutoyo</creatorcontrib><creatorcontrib>Ogawa, Hisashi</creatorcontrib><creatorcontrib>Esato, Masahiro</creatorcontrib><creatorcontrib>Chun, Yeong-Hwa</creatorcontrib><creatorcontrib>Tsuji, Hikari</creatorcontrib><creatorcontrib>Wada, Hiromichi</creatorcontrib><creatorcontrib>Hasegawa, Koji</creatorcontrib><creatorcontrib>Abe, Mitsuru</creatorcontrib><creatorcontrib>Lip, Gregory Y.H</creatorcontrib><creatorcontrib>Akao, Masaharu</creatorcontrib><title>Incidence of Stroke or Systemic Embolism in Paroxysmal Versus Sustained Atrial Fibrillation: The Fushimi Atrial Fibrillation Registry</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>BACKGROUND AND PURPOSE—There is controversy on the relationship of the type of atrial fibrillation (AF) to stroke. Although several studies show that patients with paroxysmal AF (PAF) have a stroke risk similar to those with persistent or permanent AF, recent studies suggest that PAF is associated with a lower rate of stroke. Limited data on stroke risk associated with PAF are evident in Asian populations.
METHODS—The Registry Study of Atrial Fibrillation Patients in Fushimi-ku (Fushimi AF Registry) is a community-based survey of patients with AF in Fushimi-ku, Kyoto, Japan. Patients were categorized into 2 types of AFPAF or sustained (persistent or permanent) AF. We compared clinical events between PAF (n=1588) and sustained AF (n=1716).
RESULTS—Patients with PAF were younger, had less comorbidities, and received oral anticoagulants (OAC) less commonly. A lower risk of stroke/systemic embolism during follow-up period in the patients with PAF was consistently observed (non-OAC usershazard ratio, 0.45; 95% confidence intervals, 0.27–0.75; P<0.01 and OAC usershazard ratio, 0.59; 95% confidence interval, 0.35–0.93; P=0.03). The composite end point of stroke/systemic embolism/all-cause mortality was also lower in PAF, whether among OAC users (hazard ratio, 0.77; 95% confidence interval, 0.59–0.99; P=0.046) or non-OAC users (hazard ratio, 0.59; 95% confidence interval, 0.46–0.75; P<0.01). On multivariate analysis, PAF was an independent predictor of lower stroke/systemic embolism risk.
CONCLUSIONS—In this large cohort of Japanese patients with AF, PAF was independently associated with lower incidence of stroke/systemic embolism than sustained AF. This may aid decision making for anticoagulation, especially in those patients with AF with few stroke risk factors.
CLINICAL TRIAL REGISTRATION—URLhttp://www.umin.ac.jp/ctr/index.htm. Unique identifierUMIN000005834.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - epidemiology</subject><subject>Cohort Studies</subject><subject>Embolism - diagnosis</subject><subject>Embolism - epidemiology</subject><subject>Female</subject><subject>Humans</subject><subject>Incidence</subject><subject>Japan - epidemiology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prospective Studies</subject><subject>Registries</subject><subject>Risk Factors</subject><subject>Stroke - diagnosis</subject><subject>Stroke - epidemiology</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNptUU1v1DAQtRAVXQr_ACEfuaT4M465rapdWlGpVXfhajnxhDVN4mI7KvsD-N-42tJeepp5o_fejOYh9IGSU0pr-nmzvbn6tlqeLwuUp4QSLdQrtKCSiUrUrHmNFoRwXTGh9TF6m9IvQgjjjXyDjlktqaBNs0B_L6bOO5g6wKHHmxzDbeki3uxThtF3eDW2YfBpxH7C1zaGP_s02gH_gJjmhDdzytZP4PAyR1_ma99GPww2-zB9wdsd4PWcdn70LxHwDfz0Kcf9O3TU2yHB-8d6gr6vV9uz8-ry6uvF2fKy6riionKtU72tG0mY4A3peQOsZ1Y5J6yyggvHtGOddtwyIFo75yzjvFWN65isJT9Bnw6-dzH8niFlM_rUQTlngjAnQxWvBa21IoUqDtQuhpQi9OYu-tHGvaHEPARgngIoUJpDAEX28XHD3I7gnkT_P_7sex-GXJ54O8z3EM0O7JB3pkREVK1IxQiVlBVUPYwE_wctr5PN</recordid><startdate>201512</startdate><enddate>201512</enddate><creator>Takabayashi, Kensuke</creator><creator>Hamatani, Yasuhiro</creator><creator>Yamashita, Yugo</creator><creator>Takagi, Daisuke</creator><creator>Unoki, Takashi</creator><creator>Ishii, Mitsuru</creator><creator>Iguchi, Moritake</creator><creator>Masunaga, Nobutoyo</creator><creator>Ogawa, Hisashi</creator><creator>Esato, Masahiro</creator><creator>Chun, Yeong-Hwa</creator><creator>Tsuji, Hikari</creator><creator>Wada, Hiromichi</creator><creator>Hasegawa, Koji</creator><creator>Abe, Mitsuru</creator><creator>Lip, Gregory Y.H</creator><creator>Akao, Masaharu</creator><general>American Heart Association, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201512</creationdate><title>Incidence of Stroke or Systemic Embolism in Paroxysmal Versus Sustained Atrial Fibrillation: The Fushimi Atrial Fibrillation Registry</title><author>Takabayashi, Kensuke ; Hamatani, Yasuhiro ; Yamashita, Yugo ; Takagi, Daisuke ; Unoki, Takashi ; Ishii, Mitsuru ; Iguchi, Moritake ; Masunaga, Nobutoyo ; Ogawa, Hisashi ; Esato, Masahiro ; Chun, Yeong-Hwa ; Tsuji, Hikari ; Wada, Hiromichi ; Hasegawa, Koji ; Abe, Mitsuru ; Lip, Gregory Y.H ; Akao, Masaharu</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3714-dbd7fa685024380f38e2f2a7dd4a7a434d29d2c9d3a2e099ddda233b78dc25653</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - epidemiology</topic><topic>Cohort Studies</topic><topic>Embolism - diagnosis</topic><topic>Embolism - epidemiology</topic><topic>Female</topic><topic>Humans</topic><topic>Incidence</topic><topic>Japan - epidemiology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prospective Studies</topic><topic>Registries</topic><topic>Risk Factors</topic><topic>Stroke - diagnosis</topic><topic>Stroke - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Takabayashi, Kensuke</creatorcontrib><creatorcontrib>Hamatani, Yasuhiro</creatorcontrib><creatorcontrib>Yamashita, Yugo</creatorcontrib><creatorcontrib>Takagi, Daisuke</creatorcontrib><creatorcontrib>Unoki, Takashi</creatorcontrib><creatorcontrib>Ishii, Mitsuru</creatorcontrib><creatorcontrib>Iguchi, Moritake</creatorcontrib><creatorcontrib>Masunaga, Nobutoyo</creatorcontrib><creatorcontrib>Ogawa, Hisashi</creatorcontrib><creatorcontrib>Esato, Masahiro</creatorcontrib><creatorcontrib>Chun, Yeong-Hwa</creatorcontrib><creatorcontrib>Tsuji, Hikari</creatorcontrib><creatorcontrib>Wada, Hiromichi</creatorcontrib><creatorcontrib>Hasegawa, Koji</creatorcontrib><creatorcontrib>Abe, Mitsuru</creatorcontrib><creatorcontrib>Lip, Gregory Y.H</creatorcontrib><creatorcontrib>Akao, Masaharu</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Takabayashi, Kensuke</au><au>Hamatani, Yasuhiro</au><au>Yamashita, Yugo</au><au>Takagi, Daisuke</au><au>Unoki, Takashi</au><au>Ishii, Mitsuru</au><au>Iguchi, Moritake</au><au>Masunaga, Nobutoyo</au><au>Ogawa, Hisashi</au><au>Esato, Masahiro</au><au>Chun, Yeong-Hwa</au><au>Tsuji, Hikari</au><au>Wada, Hiromichi</au><au>Hasegawa, Koji</au><au>Abe, Mitsuru</au><au>Lip, Gregory Y.H</au><au>Akao, Masaharu</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence of Stroke or Systemic Embolism in Paroxysmal Versus Sustained Atrial Fibrillation: The Fushimi Atrial Fibrillation Registry</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2015-12</date><risdate>2015</risdate><volume>46</volume><issue>12</issue><spage>3354</spage><epage>3361</epage><pages>3354-3361</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><abstract>BACKGROUND AND PURPOSE—There is controversy on the relationship of the type of atrial fibrillation (AF) to stroke. Although several studies show that patients with paroxysmal AF (PAF) have a stroke risk similar to those with persistent or permanent AF, recent studies suggest that PAF is associated with a lower rate of stroke. Limited data on stroke risk associated with PAF are evident in Asian populations.
METHODS—The Registry Study of Atrial Fibrillation Patients in Fushimi-ku (Fushimi AF Registry) is a community-based survey of patients with AF in Fushimi-ku, Kyoto, Japan. Patients were categorized into 2 types of AFPAF or sustained (persistent or permanent) AF. We compared clinical events between PAF (n=1588) and sustained AF (n=1716).
RESULTS—Patients with PAF were younger, had less comorbidities, and received oral anticoagulants (OAC) less commonly. A lower risk of stroke/systemic embolism during follow-up period in the patients with PAF was consistently observed (non-OAC usershazard ratio, 0.45; 95% confidence intervals, 0.27–0.75; P<0.01 and OAC usershazard ratio, 0.59; 95% confidence interval, 0.35–0.93; P=0.03). The composite end point of stroke/systemic embolism/all-cause mortality was also lower in PAF, whether among OAC users (hazard ratio, 0.77; 95% confidence interval, 0.59–0.99; P=0.046) or non-OAC users (hazard ratio, 0.59; 95% confidence interval, 0.46–0.75; P<0.01). On multivariate analysis, PAF was an independent predictor of lower stroke/systemic embolism risk.
CONCLUSIONS—In this large cohort of Japanese patients with AF, PAF was independently associated with lower incidence of stroke/systemic embolism than sustained AF. This may aid decision making for anticoagulation, especially in those patients with AF with few stroke risk factors.
CLINICAL TRIAL REGISTRATION—URLhttp://www.umin.ac.jp/ctr/index.htm. Unique identifierUMIN000005834.</abstract><cop>United States</cop><pub>American Heart Association, Inc</pub><pmid>26514188</pmid><doi>10.1161/STROKEAHA.115.010947</doi><tpages>8</tpages></addata></record> |
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| subjects | Aged Aged, 80 and over Atrial Fibrillation - diagnosis Atrial Fibrillation - epidemiology Cohort Studies Embolism - diagnosis Embolism - epidemiology Female Humans Incidence Japan - epidemiology Male Middle Aged Prospective Studies Registries Risk Factors Stroke - diagnosis Stroke - epidemiology |
| title | Incidence of Stroke or Systemic Embolism in Paroxysmal Versus Sustained Atrial Fibrillation: The Fushimi Atrial Fibrillation Registry |
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