AJM Theme Issue: Cardiology
Clinical research study
Trend in Mortality after Stroke with Atrial Fibrillation

https://doi.org/10.1016/j.amjmed.2005.12.027Get rights and content

Abstract

Purpose

To evaluate trend in mortality in stroke associated with atrial fibrillation, we examined mortality trend after stroke with atrial fibrillation by calendar year period (1980-1984, 1985-1989, 1990-1994, 1995-1999, and 2000-2002). We estimated trends separately for each sex in unadjusted analyses. We also adjusted for age, comorbid conditions, and general trend in mortality in the background population.

Methods

We identified all individuals, aged 40-89 years, with an incident diagnosis of stroke of any nature (ischemic or hemorrhagic) and no history of heart valve disease and a previous or concomitant diagnosis of atrial fibrillation or flutter in the Danish National Registry of Patients. Subjects were followed in the Danish Civil Registration System for emigration and vital status. We used multivariate Cox proportional hazards regression analysis to estimate trend in mortality.

Results

Incident stroke with a previous or concomitant diagnosis of nonvalvular atrial fibrillation or flutter was diagnosed in 24,470 subjects (11,554 men and 12,916 women). During 34,405 years of observation, 9237 men died, and during 35,381 years of observation, 10,827 women died. The hazard ratio for mortality after stroke in the last 3-year period compared with the first 5-year period was .65 (95% confidence interval [CI], .61-.71) in men and .69 (95% CI, .64-.74) in women.

Conclusions

We observed a substantially better survival in men and women after stroke associated with atrial fibrillation or flutter in Denmark during the years 1980 to 2002. However, we could not control for changes in admission practice, diagnostic performance, or treatment.

Section snippets

Study Period and Study Population

The study was conducted in Denmark from January 1, 1980 to December 31, 2002 (identification of incident stroke with previous or concomitant nonvalvular atrial fibrillation or flutter), and to September 10, 2004 (follow-up on vital status) in Denmark. During the study period the total population increased from about 5.1 million to 5.4 million, and the population of interest for the present study, namely subjects aged 40-89 years, increased from 2.1 to 2.5 million. The general health and

Results

During the study period from 1980 to 2002, we identified 24,470 subjects, aged 40-89 years, with an incident hospital diagnosis of stroke and a previous or concomitant diagnosis of nonvalvular atrial fibrillation or flutter; 11,554 were men and 12,916 were women. The age distribution and the proportion of men and women with a previous or a concomitant diagnosis of an endocrine or cardiovascular disease at baseline are shown in Table 1.

Discussion

We observed a marked advance in survival after stroke associated with nonvalvular atrial fibrillation or flutter. Several improvements have been introduced in medical treatment during the study period, such as oral anticoagulation, potent lipid lowering drugs, more intensive treatment of hypertension and heart failure, together with the establishment of facilities for thrombolysis, and stroke rehabilitation units. On the other hand, equipment for cerebral computed tomography or magnetic

Acknowledgments

This work was supported in part by the Clinical Institute, Aarhus University, and Western Danish Research Forum for Health Sciences.

References (25)

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  • T.F. Andersen et al.

    The Danish National Hospital RegisterA valuable source of data for modern health sciences

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