Atrial fibrillation in patients with first-ever stroke: Incidence trends and antithrombotic therapy before the event
Atrial fibrillation (AF) is the most common cardiac arrhythmia among adults. Despite the proven advantages in primary and secondary stroke prevention in patients with AF, oral anticoagulation (OAC) therapy is still underused in many countries. In this study, we investigated the incidence of AF-relat...
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Published in | PloS one Vol. 13; no. 12; p. e0209198 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
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19.12.2018
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Abstract | Atrial fibrillation (AF) is the most common cardiac arrhythmia among adults. Despite the proven advantages in primary and secondary stroke prevention in patients with AF, oral anticoagulation (OAC) therapy is still underused in many countries. In this study, we investigated the incidence of AF-related ischemic stroke over the past decade in South Korea and trends of preventive antithrombotic therapy use before stroke in a nationwide cohort.
The data source for this study was a nationwide sample cohort comprising 1,025,340 individuals that was established by the nationwide health insurance system in 2002. A total of 10,215 patients with acute ischemic stroke (AIS) were selected from the cohort between 2004 and 2013. AF was identified in 1,662 patients, and 979 patients had preexisting AF before AIS. The annual proportion of patients with AIS with AF gradually increased from 13.4% to 22.6% over the study period (p for trends <0.001). Only 14.0% of patients with high risk AF were receiving OAC before the stroke, and this proportion remained relatively constant during the study period. However, the proportion of patients treated with antiplatelet agents had increased from 18.8% in 2004 to 45.3% in 2013, while that of patients receiving no antithrombotic agent decreased from 64.6% in 2004 to 43.9% in 2013. As a limitation, no information was available about non-vitamin K antagonist oral anticoagulants, because they were widely used since late 2014 in Korea.
The number of patients with AIS and AF has steadily increased over the last 10 years in Korea. However, a small portion of patients with AF were receiving OAC therapy before the stroke and about half of the patients did not receive any antithrombotic medication. Our study demonstrates that there is huge gap between clinical practice and treatment guidelines for patients with AF in Korea. |
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AbstractList | Background Atrial fibrillation (AF) is the most common cardiac arrhythmia among adults. Despite the proven advantages in primary and secondary stroke prevention in patients with AF, oral anticoagulation (OAC) therapy is still underused in many countries. In this study, we investigated the incidence of AF-related ischemic stroke over the past decade in South Korea and trends of preventive antithrombotic therapy use before stroke in a nationwide cohort. Methods and findings The data source for this study was a nationwide sample cohort comprising 1,025,340 individuals that was established by the nationwide health insurance system in 2002. A total of 10,215 patients with acute ischemic stroke (AIS) were selected from the cohort between 2004 and 2013. AF was identified in 1,662 patients, and 979 patients had preexisting AF before AIS. The annual proportion of patients with AIS with AF gradually increased from 13.4% to 22.6% over the study period (p for trends <0.001). Only 14.0% of patients with high risk AF were receiving OAC before the stroke, and this proportion remained relatively constant during the study period. However, the proportion of patients treated with antiplatelet agents had increased from 18.8% in 2004 to 45.3% in 2013, while that of patients receiving no antithrombotic agent decreased from 64.6% in 2004 to 43.9% in 2013. As a limitation, no information was available about non-vitamin K antagonist oral anticoagulants, because they were widely used since late 2014 in Korea. Conclusions The number of patients with AIS and AF has steadily increased over the last 10 years in Korea. However, a small portion of patients with AF were receiving OAC therapy before the stroke and about half of the patients did not receive any antithrombotic medication. Our study demonstrates that there is huge gap between clinical practice and treatment guidelines for patients with AF in Korea. BACKGROUNDAtrial fibrillation (AF) is the most common cardiac arrhythmia among adults. Despite the proven advantages in primary and secondary stroke prevention in patients with AF, oral anticoagulation (OAC) therapy is still underused in many countries. In this study, we investigated the incidence of AF-related ischemic stroke over the past decade in South Korea and trends of preventive antithrombotic therapy use before stroke in a nationwide cohort. METHODS AND FINDINGSThe data source for this study was a nationwide sample cohort comprising 1,025,340 individuals that was established by the nationwide health insurance system in 2002. A total of 10,215 patients with acute ischemic stroke (AIS) were selected from the cohort between 2004 and 2013. AF was identified in 1,662 patients, and 979 patients had preexisting AF before AIS. The annual proportion of patients with AIS with AF gradually increased from 13.4% to 22.6% over the study period (p for trends <0.001). Only 14.0% of patients with high risk AF were receiving OAC before the stroke, and this proportion remained relatively constant during the study period. However, the proportion of patients treated with antiplatelet agents had increased from 18.8% in 2004 to 45.3% in 2013, while that of patients receiving no antithrombotic agent decreased from 64.6% in 2004 to 43.9% in 2013. As a limitation, no information was available about non-vitamin K antagonist oral anticoagulants, because they were widely used since late 2014 in Korea. CONCLUSIONSThe number of patients with AIS and AF has steadily increased over the last 10 years in Korea. However, a small portion of patients with AF were receiving OAC therapy before the stroke and about half of the patients did not receive any antithrombotic medication. Our study demonstrates that there is huge gap between clinical practice and treatment guidelines for patients with AF in Korea. Atrial fibrillation (AF) is the most common cardiac arrhythmia among adults. Despite the proven advantages in primary and secondary stroke prevention in patients with AF, oral anticoagulation (OAC) therapy is still underused in many countries. In this study, we investigated the incidence of AF-related ischemic stroke over the past decade in South Korea and trends of preventive antithrombotic therapy use before stroke in a nationwide cohort. The data source for this study was a nationwide sample cohort comprising 1,025,340 individuals that was established by the nationwide health insurance system in 2002. A total of 10,215 patients with acute ischemic stroke (AIS) were selected from the cohort between 2004 and 2013. AF was identified in 1,662 patients, and 979 patients had preexisting AF before AIS. The annual proportion of patients with AIS with AF gradually increased from 13.4% to 22.6% over the study period (p for trends <0.001). Only 14.0% of patients with high risk AF were receiving OAC before the stroke, and this proportion remained relatively constant during the study period. However, the proportion of patients treated with antiplatelet agents had increased from 18.8% in 2004 to 45.3% in 2013, while that of patients receiving no antithrombotic agent decreased from 64.6% in 2004 to 43.9% in 2013. As a limitation, no information was available about non-vitamin K antagonist oral anticoagulants, because they were widely used since late 2014 in Korea. The number of patients with AIS and AF has steadily increased over the last 10 years in Korea. However, a small portion of patients with AF were receiving OAC therapy before the stroke and about half of the patients did not receive any antithrombotic medication. Our study demonstrates that there is huge gap between clinical practice and treatment guidelines for patients with AF in Korea. Atrial fibrillation (AF) is the most common cardiac arrhythmia among adults. Despite the proven advantages in primary and secondary stroke prevention in patients with AF, oral anticoagulation (OAC) therapy is still underused in many countries. In this study, we investigated the incidence of AF-related ischemic stroke over the past decade in South Korea and trends of preventive antithrombotic therapy use before stroke in a nationwide cohort. The data source for this study was a nationwide sample cohort comprising 1,025,340 individuals that was established by the nationwide health insurance system in 2002. A total of 10,215 patients with acute ischemic stroke (AIS) were selected from the cohort between 2004 and 2013. AF was identified in 1,662 patients, and 979 patients had preexisting AF before AIS. The annual proportion of patients with AIS with AF gradually increased from 13.4% to 22.6% over the study period (p for trends <0.001). Only 14.0% of patients with high risk AF were receiving OAC before the stroke, and this proportion remained relatively constant during the study period. However, the proportion of patients treated with antiplatelet agents had increased from 18.8% in 2004 to 45.3% in 2013, while that of patients receiving no antithrombotic agent decreased from 64.6% in 2004 to 43.9% in 2013. As a limitation, no information was available about non-vitamin K antagonist oral anticoagulants, because they were widely used since late 2014 in Korea. The number of patients with AIS and AF has steadily increased over the last 10 years in Korea. However, a small portion of patients with AF were receiving OAC therapy before the stroke and about half of the patients did not receive any antithrombotic medication. Our study demonstrates that there is huge gap between clinical practice and treatment guidelines for patients with AF in Korea. Background Atrial fibrillation (AF) is the most common cardiac arrhythmia among adults. Despite the proven advantages in primary and secondary stroke prevention in patients with AF, oral anticoagulation (OAC) therapy is still underused in many countries. In this study, we investigated the incidence of AF-related ischemic stroke over the past decade in South Korea and trends of preventive antithrombotic therapy use before stroke in a nationwide cohort. Methods and findings The data source for this study was a nationwide sample cohort comprising 1,025,340 individuals that was established by the nationwide health insurance system in 2002. A total of 10,215 patients with acute ischemic stroke (AIS) were selected from the cohort between 2004 and 2013. AF was identified in 1,662 patients, and 979 patients had preexisting AF before AIS. The annual proportion of patients with AIS with AF gradually increased from 13.4% to 22.6% over the study period (p for trends <0.001). Only 14.0% of patients with high risk AF were receiving OAC before the stroke, and this proportion remained relatively constant during the study period. However, the proportion of patients treated with antiplatelet agents had increased from 18.8% in 2004 to 45.3% in 2013, while that of patients receiving no antithrombotic agent decreased from 64.6% in 2004 to 43.9% in 2013. As a limitation, no information was available about non-vitamin K antagonist oral anticoagulants, because they were widely used since late 2014 in Korea. Conclusions The number of patients with AIS and AF has steadily increased over the last 10 years in Korea. However, a small portion of patients with AF were receiving OAC therapy before the stroke and about half of the patients did not receive any antithrombotic medication. Our study demonstrates that there is huge gap between clinical practice and treatment guidelines for patients with AF in Korea. |
Audience | Academic |
Author | Kim, Young Dae Han, Sang Won Lee, Kyung-Yul Kim, Jinkwon Jung, Yo Han |
AuthorAffiliation | 1 Department of Neurology, Changwon Fatima Hospital, Changwon, Gyeongsangnam-do, Korea 2 Department of Neurology, Yonsei University College of Medicine, Seoul, Korea University of Miami School of Medicine, UNITED STATES 3 Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Gyeonggi-do, Korea 4 Department of Neurology, Inje University College of Medicine, Seoul, Korea 5 Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea |
AuthorAffiliation_xml | – name: 3 Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Gyeonggi-do, Korea – name: 5 Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea – name: 2 Department of Neurology, Yonsei University College of Medicine, Seoul, Korea – name: 4 Department of Neurology, Inje University College of Medicine, Seoul, Korea – name: University of Miami School of Medicine, UNITED STATES – name: 1 Department of Neurology, Changwon Fatima Hospital, Changwon, Gyeongsangnam-do, Korea |
Author_xml | – sequence: 1 givenname: Yo Han surname: Jung fullname: Jung, Yo Han organization: Department of Neurology, Changwon Fatima Hospital, Changwon, Gyeongsangnam-do, Korea – sequence: 2 givenname: Young Dae surname: Kim fullname: Kim, Young Dae organization: Department of Neurology, Yonsei University College of Medicine, Seoul, Korea – sequence: 3 givenname: Jinkwon surname: Kim fullname: Kim, Jinkwon organization: Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Gyeonggi-do, Korea – sequence: 4 givenname: Sang Won surname: Han fullname: Han, Sang Won organization: Department of Neurology, Inje University College of Medicine, Seoul, Korea – sequence: 5 givenname: Kyung-Yul orcidid: 0000-0001-5585-7739 surname: Lee fullname: Lee, Kyung-Yul organization: Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30566502$$D View this record in MEDLINE/PubMed |
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CitedBy_id | crossref_primary_10_1093_eurjpc_zwaa082 crossref_primary_10_1161_STROKEAHA_120_030138 crossref_primary_10_1001_jamanetworkopen_2023_9973 |
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Snippet | Atrial fibrillation (AF) is the most common cardiac arrhythmia among adults. Despite the proven advantages in primary and secondary stroke prevention in... Background Atrial fibrillation (AF) is the most common cardiac arrhythmia among adults. Despite the proven advantages in primary and secondary stroke... BACKGROUNDAtrial fibrillation (AF) is the most common cardiac arrhythmia among adults. Despite the proven advantages in primary and secondary stroke prevention... BACKGROUND:Atrial fibrillation (AF) is the most common cardiac arrhythmia among adults. Despite the proven advantages in primary and secondary stroke... Background Atrial fibrillation (AF) is the most common cardiac arrhythmia among adults. Despite the proven advantages in primary and secondary stroke... |
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SubjectTerms | Adult Adults Aged Aged, 80 and over Analysis Anticoagulants Arrhythmia Atrial fibrillation Atrial Fibrillation - epidemiology Brain Ischemia - epidemiology Brain Ischemia - prevention & control Cardiac arrhythmia Cardiac patients Cohort Studies Dosage and administration Drug therapy Female Fibrillation Fibrinolytic Agents - adverse effects Fibrinolytic Agents - therapeutic use Health aspects Health insurance Humans Incidence Ischemia Male Medical imaging Medicine and Health Sciences Middle Aged Patients People and Places Practice guidelines (Medicine) Republic of Korea Stroke Stroke - epidemiology Stroke - prevention & control Therapy Time Factors Trends Vitamin K |
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Title | Atrial fibrillation in patients with first-ever stroke: Incidence trends and antithrombotic therapy before the event |
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