Temporal relations between atrial fibrillation and ischaemic stroke and their prognostic impact on mortality

Journal article


Camen, Stephan, Ojeda, Francisco M., Niiranen, Teemu, Gianfagna, Francesco, Vishram-Nielsen, Julie K., Costanzo, Simona, Söderberg, Stefan, Vartiainen, Erkki, Donati, Maria Benedetta, Løchen, Maja-Lisa, Pasterkamp, Gerard, Magnussen, Christina, Kee, Frank, Jousilahti, Pekka, Hughes, Maria, Kontto, Jukka, Mathiesen, Ellisiv B., Koenig, Wolfgang, Palosaari, Tarja, ... the BiomarCaRE consortium. (2020). Temporal relations between atrial fibrillation and ischaemic stroke and their prognostic impact on mortality. Europace. 22(4), pp. 522-529. https://doi.org/10.1093/europace/euz312
AuthorsCamen, Stephan, Ojeda, Francisco M., Niiranen, Teemu, Gianfagna, Francesco, Vishram-Nielsen, Julie K., Costanzo, Simona, Söderberg, Stefan, Vartiainen, Erkki, Donati, Maria Benedetta, Løchen, Maja-Lisa, Pasterkamp, Gerard, Magnussen, Christina, Kee, Frank, Jousilahti, Pekka, Hughes, Maria, Kontto, Jukka, Mathiesen, Ellisiv B., Koenig, Wolfgang, Palosaari, Tarja, Blankenberg, Stefan, de Gaetano, Giovanni, Jørgensen, Torben, Zeller, Tanja, Kuulasmaa, Kari, Linneberg, Allan, Salomaa, Veikko, Iacoviello, Licia, Schnabel, Renate B. and the BiomarCaRE consortium
Abstract

Aims
Limited evidence is available on the temporal relationship between atrial fibrillation (AF) and ischaemic stroke and their impact on mortality in the community. We sought to understand the temporal relationship of AF and ischaemic stroke and to determine the sequence of disease onset in relation to mortality.

Methods and results
Across five prospective community cohorts of the Biomarkers for Cardiovascular Risk Assessment in Europe (BiomarCaRE) project we assessed baseline cardiovascular risk factors in 100 132 individuals, median age 46.1 (25th–75th percentile 35.8–57.5) years, 48.4% men. We followed them for incident ischaemic stroke and AF and determined the relation of subsequent disease diagnosis with overall mortality. Over a median follow-up of 16.1 years, N = 4555 individuals were diagnosed solely with AF, N = 2269 had an ischaemic stroke but no AF diagnosed, and N = 898 developed both, ischaemic stroke and AF. Temporal relationships showed a clustering of diagnosis of both diseases within the years around the diagnosis of the other disease. In multivariable-adjusted Cox regression analyses with time-dependent covariates subsequent diagnosis of AF after ischaemic stroke was associated with increased mortality [hazard ratio (HR) 4.05, 95% confidence interval (CI) 2.17–7.54; P < 0.001] which was also apparent when ischaemic stroke followed after the diagnosis of AF (HR 3.08, 95% CI 1.90–5.00; P < 0.001).

Conclusion
The temporal relations of ischaemic stroke and AF appear to be bidirectional. Ischaemic stroke may precede detection of AF by years. The subsequent diagnosis of both diseases significantly increases mortality risk. Future research needs to investigate the common underlying systemic disease processes.

Keywordsatrial fibrillation; ischaemic stroke; temporal relationship; cohort study
Year2020
JournalEuropace
Journal citation22 (4), pp. 522-529
PublisherOxford University Press
ISSN1099-5129
Digital Object Identifier (DOI)https://doi.org/10.1093/europace/euz312
Scopus EID2-s2.0-85083042692
Research or scholarlyResearch
Page range522-529
Publisher's version
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All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online18 Nov 2019
Publication process dates
Accepted27 Oct 2019
Deposited07 May 2021
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