| Full text | |
| Author(s): |
Goulart, Alessandra C.
[1, 2]
;
Olmos, Rodrigo Diaz
[1, 2]
;
Santos, Itamar S.
[1, 2]
;
Tunes, Gisela
[3]
;
Alencar, Airlane P.
[3]
;
Thomas, Neil
[4]
;
Lip, Gregory Y. H.
[5, 6, 7]
;
Lotufo, Paulo A.
[1, 2]
;
Bensenor, Isabela M.
[1, 2]
Total Authors: 9
|
| Affiliation: | [1] Univ Sao Paulo, Sch Med, Sao Paulo - Brazil
[2] Univ Sao Paulo, Hosp Univ, Ctr Clin & Epidemiol Res, Sao Paulo - Brazil
[3] Univ Sao Paulo, Inst Math & Stat, Sao Paulo - Brazil
[4] Univ Birmingham, Inst Appl Hlth Res, Birmingham, W Midlands - England
[5] Univ Liverpool, Liverpool Ctr Cardiovasc Sci, Liverpool, Merseyside - England
[6] Liverpool Heart & Chest Hosp, Liverpool, Merseyside - England
[7] Aalborg Univ, Dept Clin Med, Aalborg Thrombosis Res Unit, Aalborg - Denmark
Total Affiliations: 7
|
| Document type: | Journal article |
| Source: | International Journal of Stroke; v. 17, n. 1, p. 48-58, JAN 2022. |
| Web of Science Citations: | 1 |
| Abstract | |
Background Atrial fibrillation is a predictor of poor prognosis after stroke. Aims To evaluate atrial fibrillation and all-cause and cardiovascular mortality in a stroke cohort with low socioeconomic status, taking into consideration oral anticoagulant use during 12-year follow-up. Methods All-cause mortality was analyzed by Kaplan-Meier survival curve and Cox regression models to estimate hazard ratios and 95% confidence intervals (95% CI). For specific mortality causes, cumulative incidence functions were computed. A logit link function was used to calculate odds ratios (OR) with 95% CIs. Full models were adjusted by age, sex, oral anticoagulant use (as a time-dependent variable) and cardiovascular risk factors. Results Of 1121 ischemic stroke participants, 17.8% had atrial fibrillation. Overall, 654 deaths (58.3%) were observed. Survival rate was lower (median days, interquartile range-IQR) among those with atrial fibrillation (531, IQR: 46-2039) vs. non-atrial fibrillation (1808, IQR: 334-3301), p-log rank < 0.0001). Over 12-year follow-up, previous atrial fibrillation was associated with increased mortality: all-cause (multivariable hazard ratios, 1.82; 95% CI: 1.43-2.31) and cardiovascular mortality (multivariable OR, 2.07; 95% CI: 1.36-3.14), but not stroke mortality. In the same multivariable models, oral anticoagulant use was inversely associated with all-cause mortality (oral anticoagulant time-dependent effect: multivariable hazard ratios, 0.47; 95% CI: 0.30-0.50, p = 0.002) and stroke mortality (oral anticoagulant time-dependent effect >= 6 months: multivariable OR, 0.09; 95% CI: 0.01-0.65, p-value = 0.02), but not cardiovascular mortality. Conclusions Among individuals with low socioeconomic status, atrial fibrillation was an independent predictor of poor survival, increasing all-cause and cardiovascular mortality risk. Long-term oral anticoagulant use was associated with a markedly reduced risk of all-cause and stroke mortality. (AU) | |
| FAPESP's process: | 18/05512-3 - PROGNOSTIC FACTORS ASSOCIATED WITH MORTALITY AND SURVIVAL UP TO 12 YEARS OF FOLLOW-UP IN THE MORTALITY AND MORBIDITY STROKE STUDY (EMMA STUDY). |
| Grantee: | Alessandra Carvalho Goulart |
| Support Opportunities: | Regular Research Grants |