The impact of atrial fibrillation and long-term oral anticoagulant use on all-cause and cardiovascular mortality: A 12-year evaluation of the prospective Brazilian Study of Stroke Mortality and Morbidity

Autor(es)

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]}

Afiliação do(s) autor(es)

^[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

• Tipo de documento: Artigo Científico
• Fonte: International Journal of Stroke; v. 17, n. 1, p. 48-58, JAN 2022.
• Citações Web of Science: 1

Resumo

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)

• Processo FAPESP: 18/05512-3 - Fatores prognósticos associados à mortalidade e sobrevida em até 12 anos de seguimento no estudo de mortalidade e morbidade do acidente vascular cerebral (estudo emma)
• Beneficiário: Alessandra Carvalho Goulart
• Modalidade de apoio: Auxílio à Pesquisa - Regular