Relationship between temporal rhythm-based classification of atrial fibrillation and stroke:real-world vs. clinical trial
| Autor: | Wern Yew Ding, José Miguel Rivera-Caravaca, Francisco Marin, Vanessa Roldán, Gregory Y. H. Lip |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
Risk
Male Anticoagulants Brain Ischemia/drug therapy Hematology Classification Risk Assessment Atrial fibrillation CHA DS -VASc Brain Ischemia Clinical trial Stroke Real-world Anticoagulants/therapeutic use Risk Factors Thromboembolism Atrial Fibrillation Humans Cardiology and Cardiovascular Medicine Risk Assessment/methods Atrial Fibrillation/complications Thromboembolism/etiology AF type Stroke/complications |
| Zdroj: | Ding, W Y, Rivera-Caravaca, J M, Marin, F, Roldán, V & Lip, G Y H 2022, ' Relationship between temporal rhythm-based classification of atrial fibrillation and stroke : real-world vs. clinical trial ', Journal of Thrombosis and Thrombolysis, vol. 54, pp. 1-6 . https://doi.org/10.1007/s11239-022-02638-0 |
| DOI: | 10.1007/s11239-022-02638-0 |
| Popis: | Background The risk of stroke according to clinical classification of atrial fibrillation (AF) remains poorly defined. Here, we assessed the impact of AF type on stroke risk in vitamin K antagonist-treated patients with AF in ‘real-world’ and ‘clinical trial’ cohorts. Methods Post-hoc analysis of patient-level data from the Murcia AF Project and AMADEUS trial. Clinical classification of AF was based on contemporary recommendations from international guidelines. Study endpoint was the incidence rate of ischaemic stroke. Stroke risk was determined using CHA2DS2-VASc score and CARS. A modified CHA2DS2-VAS‘c’ score that applied one additional point for a ‘c’ criterion of continuous AF (i.e. non-paroxysmal AF) was calculated. Results We included 5,917 patients: 1,361 (23.0%) real-world and 4,556 (77.0%) clinical trial. Baseline demographics were balanced in the real-world cohort but clinical trial participants with non-pAF (vs. pAF) were older, male-predominant and had more comorbidities. Crude stroke rates were comparable between the groups in real-world patients (IRR 0.72 [95% CI,0.37-1.28], p = 0.259) though clinical trial participants with non-pAF had a significantly higher crude rate of stroke events (IRR 4.66 [95%,CI,2.41-9.48], p p = 0.239) and clinical trial (adjusted HR 1.16 [95% CI,0.62-2.20], p = 0.646) cohorts, after accounting for other risk factors. There was no significant improvement in the CHA2DS2-VAS‘c’ compared to CHA2DS2-VASc score in either cohorts (p > 0.05). Conclusions Overall, our results support the need for anticoagulation based on thromboembolic risk profile rather than AF type. |
| Databáze: | OpenAIRE |
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