Number of Previous Strokes and the Association With Clinical Outcomes of Patients With Atrial Fibrillation: Longitudinal Data From the GLORIA‐AF Registry
Background Patients with atrial fibrillation (AF) who suffered a previous stroke are at increased risk of recurrent thromboembolic events and other major outcomes. The impact of the number of stroke episodes on the natural history of patients with AF is still unclear. Methods and Results Using data...
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Wiley
2025-01-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.038448 |
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| author | Steven Ho Man Lam Giulio Francesco Romiti Bernadette Corica Tommaso Bucci Brian Olshansky Tze‐Fan Chao Menno V. Huisman Gregory Y. H. Lip |
| author_facet | Steven Ho Man Lam Giulio Francesco Romiti Bernadette Corica Tommaso Bucci Brian Olshansky Tze‐Fan Chao Menno V. Huisman Gregory Y. H. Lip |
| author_sort | Steven Ho Man Lam |
| collection | DOAJ |
| description | Background Patients with atrial fibrillation (AF) who suffered a previous stroke are at increased risk of recurrent thromboembolic events and other major outcomes. The impact of the number of stroke episodes on the natural history of patients with AF is still unclear. Methods and Results Using data from the international, multicenter, and prospective GLORIA‐AF (Global Registry on Long‐Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation) Registry Phase III, we categorized patients with a recent diagnosis of non‐valvular AF according to the number of previous strokes (either 0, 1, or ≥2 episodes). We analyzed use of oral anticoagulants through multiple logistic regression model, and risk of major outcomes using multiple Cox‐regression models; our primary outcome was all‐cause death. Among 21 223 patients (mean age: 70.2±10.3 years; 44.9% female) included, 2251 (10.6%) had a previous history of stroke, and 216 (1.0%) had ≥2 or more strokes. Oral anticoagulants were used in ≥80% of patients regardless of the numbers of previous stroke, although those with 1 (versus >1) prior stroke showed lower odds of receiving oral anticoagulants (odds ratio [95% CI]: 0.83 [0.73–0.94]). During 3‐years follow‐up, the risk of all‐cause mortality increased with the number of previous strokes (hazard ratio [95% CI]: 1.46 [1.28–1.67] and 2.43 [1.79–3.29] for 1 versus 0 and ≥2 versus 0 previous strokes, respectively). Similar results were observed for other secondary outcomes, including thromboembolism, but not for major bleeding. Conclusions History of stroke still represents a key risk factor in patients with AF. Patients who suffered more than 1 episodes of stroke had significantly worse prognosis and further efforts may be required to improve their clinical outcomes. |
| format | Article |
| id | doaj-art-e451cf61bf79454b9aeb08beed0542c2 |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-e451cf61bf79454b9aeb08beed0542c22025-08-20T02:34:38ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-01-0114210.1161/JAHA.124.038448Number of Previous Strokes and the Association With Clinical Outcomes of Patients With Atrial Fibrillation: Longitudinal Data From the GLORIA‐AF RegistrySteven Ho Man Lam0Giulio Francesco Romiti1Bernadette Corica2Tommaso Bucci3Brian Olshansky4Tze‐Fan Chao5Menno V. Huisman6Gregory Y. H. Lip7Liverpool Centre for Cardiovascular Sciences at University of Liverpool Liverpool John Moores University and Liverpool Heart & Chest Hospital Liverpool UKLiverpool Centre for Cardiovascular Sciences at University of Liverpool Liverpool John Moores University and Liverpool Heart & Chest Hospital Liverpool UKLiverpool Centre for Cardiovascular Sciences at University of Liverpool Liverpool John Moores University and Liverpool Heart & Chest Hospital Liverpool UKLiverpool Centre for Cardiovascular Sciences at University of Liverpool Liverpool John Moores University and Liverpool Heart & Chest Hospital Liverpool UKDivision of Cardiology, Department of Medicine University of Iowa Iowa City IA USADivision of Cardiology, Department of Medicine Taipei Veterans General Hospital Taipei TaiwanDepartment of Thrombosis and Hemostasis Leiden University Medical Center Leiden the NetherlandsLiverpool Centre for Cardiovascular Sciences at University of Liverpool Liverpool John Moores University and Liverpool Heart & Chest Hospital Liverpool UKBackground Patients with atrial fibrillation (AF) who suffered a previous stroke are at increased risk of recurrent thromboembolic events and other major outcomes. The impact of the number of stroke episodes on the natural history of patients with AF is still unclear. Methods and Results Using data from the international, multicenter, and prospective GLORIA‐AF (Global Registry on Long‐Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation) Registry Phase III, we categorized patients with a recent diagnosis of non‐valvular AF according to the number of previous strokes (either 0, 1, or ≥2 episodes). We analyzed use of oral anticoagulants through multiple logistic regression model, and risk of major outcomes using multiple Cox‐regression models; our primary outcome was all‐cause death. Among 21 223 patients (mean age: 70.2±10.3 years; 44.9% female) included, 2251 (10.6%) had a previous history of stroke, and 216 (1.0%) had ≥2 or more strokes. Oral anticoagulants were used in ≥80% of patients regardless of the numbers of previous stroke, although those with 1 (versus >1) prior stroke showed lower odds of receiving oral anticoagulants (odds ratio [95% CI]: 0.83 [0.73–0.94]). During 3‐years follow‐up, the risk of all‐cause mortality increased with the number of previous strokes (hazard ratio [95% CI]: 1.46 [1.28–1.67] and 2.43 [1.79–3.29] for 1 versus 0 and ≥2 versus 0 previous strokes, respectively). Similar results were observed for other secondary outcomes, including thromboembolism, but not for major bleeding. Conclusions History of stroke still represents a key risk factor in patients with AF. Patients who suffered more than 1 episodes of stroke had significantly worse prognosis and further efforts may be required to improve their clinical outcomes.https://www.ahajournals.org/doi/10.1161/JAHA.124.038448atrial fibrillationcardiovascular risknumber of stroke events |
| spellingShingle | Steven Ho Man Lam Giulio Francesco Romiti Bernadette Corica Tommaso Bucci Brian Olshansky Tze‐Fan Chao Menno V. Huisman Gregory Y. H. Lip Number of Previous Strokes and the Association With Clinical Outcomes of Patients With Atrial Fibrillation: Longitudinal Data From the GLORIA‐AF Registry Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atrial fibrillation cardiovascular risk number of stroke events |
| title | Number of Previous Strokes and the Association With Clinical Outcomes of Patients With Atrial Fibrillation: Longitudinal Data From the GLORIA‐AF Registry |
| title_full | Number of Previous Strokes and the Association With Clinical Outcomes of Patients With Atrial Fibrillation: Longitudinal Data From the GLORIA‐AF Registry |
| title_fullStr | Number of Previous Strokes and the Association With Clinical Outcomes of Patients With Atrial Fibrillation: Longitudinal Data From the GLORIA‐AF Registry |
| title_full_unstemmed | Number of Previous Strokes and the Association With Clinical Outcomes of Patients With Atrial Fibrillation: Longitudinal Data From the GLORIA‐AF Registry |
| title_short | Number of Previous Strokes and the Association With Clinical Outcomes of Patients With Atrial Fibrillation: Longitudinal Data From the GLORIA‐AF Registry |
| title_sort | number of previous strokes and the association with clinical outcomes of patients with atrial fibrillation longitudinal data from the gloria af registry |
| topic | atrial fibrillation cardiovascular risk number of stroke events |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.038448 |
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