Frequency of cardioversions as an additional risk factor for stroke in atrial fibrillation – the FinCV-4 study
Background Patients with atrial fibrillation (AF) are selected for oral anticoagulation based on individual patient characteristics. There is little information on how clinical AF burden associates with the risk of ischaemic stroke or systemic embolism (SSE). The aim of this study was to explore the...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2022-12-01
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| Series: | Annals of Medicine |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/07853890.2022.2077430 |
| _version_ | 1818548032352813056 |
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| author | Samuli Jaakkola Tuomas O. Kiviniemi Jussi Jaakkola Jussi-Pekka Pouru Ilpo Nuotio Tuija Vasankari Juha E. K. Hartikainen K. E. Juhani Airaksinen |
| author_facet | Samuli Jaakkola Tuomas O. Kiviniemi Jussi Jaakkola Jussi-Pekka Pouru Ilpo Nuotio Tuija Vasankari Juha E. K. Hartikainen K. E. Juhani Airaksinen |
| author_sort | Samuli Jaakkola |
| collection | DOAJ |
| description | Background Patients with atrial fibrillation (AF) are selected for oral anticoagulation based on individual patient characteristics. There is little information on how clinical AF burden associates with the risk of ischaemic stroke or systemic embolism (SSE). The aim of this study was to explore the association of the frequency of cardioversions (CV) as a measure of clinical AF burden on the long-term SSE risk, with a focus on patients at intermediate stroke risk based on CHA2DS2-VASc score. For these patients, additional SSE risk stratification by assessing CV frequency may aid in the decision on whether to initiate oral anticoagulation.Methods This retrospective analysis of FinCV Study from years 2003–2010 included 2074 patients who were not using any oral anticoagulation (long term or temporary) after CVs and undergoing a total of 6534 CVs for AF from emergency departments of three hospitals. Two study groups were formed: high CV frequency (mean interval between CVs ≤12 months and low frequency (>12 months).Results A total of 107 SSEs occurred during a mean follow-up of 5.4 years. The event rates per 100 patient-years were 1.82 and 0.67 in high versus low CV frequency groups, respectively. After adjustment for CHA2DS2-VASc score, CV frequency independently predicted SSE (HR, 2.87 [95% CI, 1.47 to 5.64]; p = .002) at 3 years. Competing risk analysis also identified CV frequency (sHR, 2.70 [95% CI, 1.38–5.31]; p = .004) as an independent predictor for SSE. In patients with CHA2DS2-VASc score 1 and low CV frequency, the SSE risk was only 0.08 per 100 patient-years.Conclusions Frequency of CVs for symptomatic AF episodes provides additional information on stroke risk in AF patients with CHA2DS2-VASc score 1.Key messagesThis retrospective study offers a unique opportunity to observe the natural course of AF patients with infrequent episodes of clinical arrhythmia when they were not using OAC (before introduction of CHA2DS2-VASc score).Stroke or systemic embolism rate was very low (0.08 per 100 patient-years) in patients with one CHA2DS2-VASc point who visited the emergency room for cardioversion less than once a year.Frequency of cardioversions can be used for additional risk stratification in patients at intermediate risk of stroke based on CHA2DS2-VASc score. |
| first_indexed | 2024-12-12T08:14:33Z |
| format | Article |
| id | doaj.art-98e8eddcda424a7681a69901f039eae5 |
| institution | Directory Open Access Journal |
| issn | 0785-3890 1365-2060 |
| language | English |
| last_indexed | 2024-12-12T08:14:33Z |
| publishDate | 2022-12-01 |
| publisher | Taylor & Francis Group |
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| series | Annals of Medicine |
| spelling | doaj.art-98e8eddcda424a7681a69901f039eae52022-12-22T00:31:39ZengTaylor & Francis GroupAnnals of Medicine0785-38901365-20602022-12-015411452145810.1080/07853890.2022.2077430Frequency of cardioversions as an additional risk factor for stroke in atrial fibrillation – the FinCV-4 studySamuli Jaakkola0Tuomas O. Kiviniemi1Jussi Jaakkola2Jussi-Pekka Pouru3Ilpo Nuotio4Tuija Vasankari5Juha E. K. Hartikainen6K. E. Juhani Airaksinen7Heart Center, Turku University Hospital and University of Turku, Turku, FinlandHeart Center, Turku University Hospital and University of Turku, Turku, FinlandHeart Center, Turku University Hospital and University of Turku, Turku, FinlandHeart Center, Turku University Hospital and University of Turku, Turku, FinlandDepartment of Acute Internal Medicine, Turku University Hospital and University of Turku, Turku, FinlandHeart Center, Turku University Hospital and University of Turku, Turku, FinlandHeart Center, Kuopio University Hospital, Kuopio, FinlandHeart Center, Turku University Hospital and University of Turku, Turku, FinlandBackground Patients with atrial fibrillation (AF) are selected for oral anticoagulation based on individual patient characteristics. There is little information on how clinical AF burden associates with the risk of ischaemic stroke or systemic embolism (SSE). The aim of this study was to explore the association of the frequency of cardioversions (CV) as a measure of clinical AF burden on the long-term SSE risk, with a focus on patients at intermediate stroke risk based on CHA2DS2-VASc score. For these patients, additional SSE risk stratification by assessing CV frequency may aid in the decision on whether to initiate oral anticoagulation.Methods This retrospective analysis of FinCV Study from years 2003–2010 included 2074 patients who were not using any oral anticoagulation (long term or temporary) after CVs and undergoing a total of 6534 CVs for AF from emergency departments of three hospitals. Two study groups were formed: high CV frequency (mean interval between CVs ≤12 months and low frequency (>12 months).Results A total of 107 SSEs occurred during a mean follow-up of 5.4 years. The event rates per 100 patient-years were 1.82 and 0.67 in high versus low CV frequency groups, respectively. After adjustment for CHA2DS2-VASc score, CV frequency independently predicted SSE (HR, 2.87 [95% CI, 1.47 to 5.64]; p = .002) at 3 years. Competing risk analysis also identified CV frequency (sHR, 2.70 [95% CI, 1.38–5.31]; p = .004) as an independent predictor for SSE. In patients with CHA2DS2-VASc score 1 and low CV frequency, the SSE risk was only 0.08 per 100 patient-years.Conclusions Frequency of CVs for symptomatic AF episodes provides additional information on stroke risk in AF patients with CHA2DS2-VASc score 1.Key messagesThis retrospective study offers a unique opportunity to observe the natural course of AF patients with infrequent episodes of clinical arrhythmia when they were not using OAC (before introduction of CHA2DS2-VASc score).Stroke or systemic embolism rate was very low (0.08 per 100 patient-years) in patients with one CHA2DS2-VASc point who visited the emergency room for cardioversion less than once a year.Frequency of cardioversions can be used for additional risk stratification in patients at intermediate risk of stroke based on CHA2DS2-VASc score.https://www.tandfonline.com/doi/10.1080/07853890.2022.2077430Atrial fibrillationstrokecardioversion |
| spellingShingle | Samuli Jaakkola Tuomas O. Kiviniemi Jussi Jaakkola Jussi-Pekka Pouru Ilpo Nuotio Tuija Vasankari Juha E. K. Hartikainen K. E. Juhani Airaksinen Frequency of cardioversions as an additional risk factor for stroke in atrial fibrillation – the FinCV-4 study Annals of Medicine Atrial fibrillation stroke cardioversion |
| title | Frequency of cardioversions as an additional risk factor for stroke in atrial fibrillation – the FinCV-4 study |
| title_full | Frequency of cardioversions as an additional risk factor for stroke in atrial fibrillation – the FinCV-4 study |
| title_fullStr | Frequency of cardioversions as an additional risk factor for stroke in atrial fibrillation – the FinCV-4 study |
| title_full_unstemmed | Frequency of cardioversions as an additional risk factor for stroke in atrial fibrillation – the FinCV-4 study |
| title_short | Frequency of cardioversions as an additional risk factor for stroke in atrial fibrillation – the FinCV-4 study |
| title_sort | frequency of cardioversions as an additional risk factor for stroke in atrial fibrillation the fincv 4 study |
| topic | Atrial fibrillation stroke cardioversion |
| url | https://www.tandfonline.com/doi/10.1080/07853890.2022.2077430 |
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