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. 1998 Mar;88(3):395–400. doi: 10.2105/ajph.88.3.395

Atrial fibrillation as a risk factor for stroke: a retrospective cohort study of hospitalized Medicare beneficiaries.

Z Yuan 1, S Bowlin 1, D Einstadter 1, R D Cebul 1, A R Conners Jr 1, A A Rimm 1
PMCID: PMC1508341  PMID: 9518970

Abstract

OBJECTIVES: This study examined the relationship between atrial fibrillation and (1) stroke and (2) all-cause mortality. METHODS: All eligible Medicare patients older than 65 years of age hospitalized in 1985 were followed up for 4 years. Kaplan-Meier and Cox proportional hazards models were used for assessment of risk of stroke and mortality. RESULTS: A total of 4,282,607 eligible Medicare patients were hospitalized in 1985. The mean age was 76.1 (+/- 7.7) years; 58.7% were female; 7.2% were Black; and 8.4% had a diagnosis of atrial fibrillation. During the follow-up period, 66,063 patients (32.6/1000 person-years) developed nonembolic stroke and 7285 (3.6/1000 person-years) developed embolic stroke. After adjustment for age, race, sex, and comorbid conditions, atrial fibrillation remained a significant risk factor for both nonembolic stroke (relative risk [RR] = 1.56) and embolic stroke (RR = 5.80) and for mortality (RR = 1.31). Approximately 4.5% of nonembolic and 28.7% of embolic strokes among hospitalized Medicare patients aged 65 years and older were attributable to atrial fibrillation. CONCLUSIONS: This study demonstrates that atrial fibrillation is associated with an appreciable increase in the risk of stroke (both embolic and nonembolic) and in the risk of mortality from all causes.

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Selected References

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  1. Albers G. W. Atrial fibrillation and stroke. Three new studies, three remaining questions. Arch Intern Med. 1994 Jul 11;154(13):1443–1448. [PubMed] [Google Scholar]
  2. Bogousslavsky J., Van Melle G., Regli F., Kappenberger L. Pathogenesis of anterior circulation stroke in patients with nonvalvular atrial fibrillation: the Lausanne Stroke Registry. Neurology. 1990 Jul;40(7):1046–1050. doi: 10.1212/wnl.40.7.1046. [DOI] [PubMed] [Google Scholar]
  3. Britton M., Gustafsson C. Non-rheumatic atrial fibrillation as a risk factor for stroke. Stroke. 1985 Mar-Apr;16(2):182–188. doi: 10.1161/01.str.16.2.182. [DOI] [PubMed] [Google Scholar]
  4. CASELLA L., ABELMANN W. H., ELLIS L. B. PATIENTS WITH MITRAL STENOSIS AND SYSTEMIC EMBOLI; HEMODYNAMIC AND CLINICAL OBSERVATIONS. Arch Intern Med. 1964 Dec;114:773–781. doi: 10.1001/archinte.1964.03860120085008. [DOI] [PubMed] [Google Scholar]
  5. Cairns J. A., Connolly S. J. Nonrheumatic atrial fibrillation. Risk of stroke and role of antithrombotic therapy. Circulation. 1991 Aug;84(2):469–481. doi: 10.1161/01.cir.84.2.469. [DOI] [PubMed] [Google Scholar]
  6. Chesebro J. H., Fuster V., Halperin J. L. Atrial fibrillation--risk marker for stroke. N Engl J Med. 1990 Nov 29;323(22):1556–1558. doi: 10.1056/NEJM199011293232209. [DOI] [PubMed] [Google Scholar]
  7. DALEY R., MATTINGLY T. W., HOLT C. L., BLAND E. F., WHITE P. D. Systemic arterial embolism in rheumatic heart disease. Am Heart J. 1951 Oct;42(4):566–581. doi: 10.1016/0002-8703(51)90152-4. [DOI] [PubMed] [Google Scholar]
  8. Davis P. H., Dambrosia J. M., Schoenberg B. S., Schoenberg D. G., Pritchard D. A., Lilienfeld A. M., Whisnant J. P. Risk factors for ischemic stroke: a prospective study in Rochester, Minnesota. Ann Neurol. 1987 Sep;22(3):319–327. doi: 10.1002/ana.410220307. [DOI] [PubMed] [Google Scholar]
  9. Feinberg W. M., Blackshear J. L., Laupacis A., Kronmal R., Hart R. G. Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications. Arch Intern Med. 1995 Mar 13;155(5):469–473. [PubMed] [Google Scholar]
  10. Fisher E. S., Baron J. A., Malenka D. J., Barrett J., Bubolz T. A. Overcoming potential pitfalls in the use of Medicare data for epidemiologic research. Am J Public Health. 1990 Dec;80(12):1487–1490. doi: 10.2105/ajph.80.12.1487. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Fisher E. S., Whaley F. S., Krushat W. M., Malenka D. J., Fleming C., Baron J. A., Hsia D. C. The accuracy of Medicare's hospital claims data: progress has been made, but problems remain. Am J Public Health. 1992 Feb;82(2):243–248. doi: 10.2105/ajph.82.2.243. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Friedman G. D., Loveland D. B., Ehrlich S. P., Jr Relationship of stroke to other cardiovascular disease. Circulation. 1968 Sep;38(3):533–541. doi: 10.1161/01.cir.38.3.533. [DOI] [PubMed] [Google Scholar]
  13. Jacobsen S. J., Goldberg J., Miles T. P., Brody J. A., Stiers W., Rimm A. A. Hip fracture incidence among the old and very old: a population-based study of 745,435 cases. Am J Public Health. 1990 Jul;80(7):871–873. doi: 10.2105/ajph.80.7.871. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Kannel W. B., Abbott R. D., Savage D. D., McNamara P. M. Coronary heart disease and atrial fibrillation: the Framingham Study. Am Heart J. 1983 Aug;106(2):389–396. doi: 10.1016/0002-8703(83)90208-9. [DOI] [PubMed] [Google Scholar]
  15. Kannel W. B., Abbott R. D., Savage D. D., McNamara P. M. Epidemiologic features of chronic atrial fibrillation: the Framingham study. N Engl J Med. 1982 Apr 29;306(17):1018–1022. doi: 10.1056/NEJM198204293061703. [DOI] [PubMed] [Google Scholar]
  16. Kelley R. E., Berger J. R., Alter M., Kovacs A. G. Cerebral ischemia and atrial fibrillation: prospective study. Neurology. 1984 Oct;34(10):1285–1291. doi: 10.1212/wnl.34.10.1285. [DOI] [PubMed] [Google Scholar]
  17. Lavy S., Stern S., Melamed E., Cooper G., Keren A., Levy P. Effect of chronic atrial fibrillation on regional cerebral blood flow. Stroke. 1980 Jan-Feb;11(1):35–38. doi: 10.1161/01.str.11.1.35. [DOI] [PubMed] [Google Scholar]
  18. McGinnis J. M., Ballard-Barbash R. M. Obesity in minority populations: policy implications of research. Am J Clin Nutr. 1991 Jun;53(6 Suppl):1512S–1514S. doi: 10.1093/ajcn/53.6.1512S. [DOI] [PubMed] [Google Scholar]
  19. Oldridge N. B., Yuan Z., Stoll J. E., Rimm A. R. Lumbar spine surgery and mortality among Medicare beneficiaries, 1986. Am J Public Health. 1994 Aug;84(8):1292–1298. doi: 10.2105/ajph.84.8.1292. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Petersen P., Kastrup J., Videbaek R., Boysen G. Cerebral blood flow before and after cardioversion of atrial fibrillation. J Cereb Blood Flow Metab. 1989 Jun;9(3):422–425. doi: 10.1038/jcbfm.1989.62. [DOI] [PubMed] [Google Scholar]
  21. Phillips S. J. Is atrial fibrillation an independent risk factor for stroke? Can J Neurol Sci. 1990 May;17(2):163–168. doi: 10.1017/s0317167100030390. [DOI] [PubMed] [Google Scholar]
  22. Phillips S. J., Whisnant J. P., O'Fallon W. M., Frye R. L. Prevalence of cardiovascular disease and diabetes mellitus in residents of Rochester, Minnesota. Mayo Clin Proc. 1990 Mar;65(3):344–359. doi: 10.1016/s0025-6196(12)62535-x. [DOI] [PubMed] [Google Scholar]
  23. Pickering T. G. Hypertension in blacks. Curr Opin Nephrol Hypertens. 1994 Mar;3(2):207–212. doi: 10.1097/00041552-199403000-00012. [DOI] [PubMed] [Google Scholar]
  24. Steinberg E. P., Whittle J., Anderson G. F. Impact of claims data research on clinical practice. Int J Technol Assess Health Care. 1990;6(2):282–287. doi: 10.1017/s0266462300000805. [DOI] [PubMed] [Google Scholar]
  25. Summerson J. H., Konen J. C., Dignan M. B. Race-related differences in metabolic control among adults with diabetes. South Med J. 1992 Oct;85(10):953–956. doi: 10.1097/00007611-199210000-00005. [DOI] [PubMed] [Google Scholar]
  26. Welin L., Svärdsudd K., Wilhelmsen L., Larsson B., Tibblin G. Analysis of risk factors for stroke in a cohort of men born in 1913. N Engl J Med. 1987 Aug 27;317(9):521–526. doi: 10.1056/NEJM198708273170901. [DOI] [PubMed] [Google Scholar]
  27. Wolf P. A., Abbott R. D., Kannel W. B. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991 Aug;22(8):983–988. doi: 10.1161/01.str.22.8.983. [DOI] [PubMed] [Google Scholar]
  28. Wolf P. A., Abbott R. D., Kannel W. B. Atrial fibrillation: a major contributor to stroke in the elderly. The Framingham Study. Arch Intern Med. 1987 Sep;147(9):1561–1564. [PubMed] [Google Scholar]
  29. Wolf P. A., Dawber T. R., Thomas H. E., Jr, Kannel W. B. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study. Neurology. 1978 Oct;28(10):973–977. doi: 10.1212/wnl.28.10.973. [DOI] [PubMed] [Google Scholar]

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