Association of atrial fibrillation with incidence of extracranial systemic embolic events: The aric study

Mengyuan Shi; Lin Y. Chen; Wobo Bekwelem; Faye L. Norby; Elsayed Z. Soliman; Aniqa B. Alam; Alvaro Alonso

doi:10.1161/JAHA.120.016724

Association of atrial fibrillation with incidence of extracranial systemic embolic events: The aric study

Mengyuan Shi, Lin Y. Chen, Wobo Bekwelem, Faye L. Norby, Elsayed Z. Soliman, Aniqa B. Alam, Alvaro Alonso

Epidemiology & Community Health

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

BACKGROUND: Atrial fibrillation (AF) increases the risk of stroke and extracranial systemic embolic events (SEEs), but little is known about the magnitude of the association of AF with SEE. METHODS AND RESULTS: This analysis included 14 941 participants of the ARIC (Atherosclerosis Risk in Communities) study (mean age, 54.2±5.8, 55% women, 74% White) without AF at baseline (1987–1989) followed through 2017. AF was identified from study ECGs, hospital discharges, and death certificates, while SEEs were ascertained from hospital discharges. CHA₂ DS₂-VASc was calculated at the time of AF diagnosis. Cox regression was used to estimate associations of incident AF with SEE risk in the entire cohort, and between CHA₂ DS₂-VASc score and SEE risk in those with AF. Among eligible participants, 3114 participants developed AF and 270 had an SEE (59 events in AF). Incident AF was associated with increased risk of SEE (hazard ratio [HR], 3.58; 95% CI, 2.57–5.00), after adjusting for covariates. The association of incident AF with SEE was stronger in women (HR, 5.26; 95% CI, 3.28–8.44) than in men (HR, 2.68; 95% CI, 1.66–4.32). In those with AF, higher CHA₂ DS₂-VASc score was associated with increased SEE risk (HR per 1-point increase, 1.24; 95% CI, 1.05–1.47). CONCLUSIONS: AF is associated with more than a tripling of the risk of SEE, with a stronger association in women than in men. CHA₂ DS₂-VASc is associated with SEE risk in AF patients, highlighting the value of the score to predict adverse outcomes and guide treatment decisions in people with AF.

Original language	English (US)
Article number	e016724
Journal	Journal of the American Heart Association
Volume	9
Issue number	18
DOIs	https://doi.org/10.1161/JAHA.120.016724
State	Published - Nov 3 2020

Bibliographical note

Funding Information:
The ARIC study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract nos. (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I). This work was additionally supported by American Heart Association grant 16EIA26410001 (Alonso) and National Heart, Lung, and Blood Institute K24HL148521.

Funding Information:
The ARIC study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract nos. (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I). This work was additionally supported by American Heart Association grant 16EIA26410001 (Alonso) and National Heart, Lung, and Blood InstituteK24HL148521.

Publisher Copyright:
© 2020 The Authors.

Keywords

Atrial fibrillation
CHA DS-VASc score
Extracranial systemic embolism

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10.1161/JAHA.120.016724

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title = "Association of atrial fibrillation with incidence of extracranial systemic embolic events: The aric study",

abstract = "BACKGROUND: Atrial fibrillation (AF) increases the risk of stroke and extracranial systemic embolic events (SEEs), but little is known about the magnitude of the association of AF with SEE. METHODS AND RESULTS: This analysis included 14 941 participants of the ARIC (Atherosclerosis Risk in Communities) study (mean age, 54.2±5.8, 55% women, 74% White) without AF at baseline (1987–1989) followed through 2017. AF was identified from study ECGs, hospital discharges, and death certificates, while SEEs were ascertained from hospital discharges. CHA2 DS2-VASc was calculated at the time of AF diagnosis. Cox regression was used to estimate associations of incident AF with SEE risk in the entire cohort, and between CHA2 DS2-VASc score and SEE risk in those with AF. Among eligible participants, 3114 participants developed AF and 270 had an SEE (59 events in AF). Incident AF was associated with increased risk of SEE (hazard ratio [HR], 3.58; 95% CI, 2.57–5.00), after adjusting for covariates. The association of incident AF with SEE was stronger in women (HR, 5.26; 95% CI, 3.28–8.44) than in men (HR, 2.68; 95% CI, 1.66–4.32). In those with AF, higher CHA2 DS2-VASc score was associated with increased SEE risk (HR per 1-point increase, 1.24; 95% CI, 1.05–1.47). CONCLUSIONS: AF is associated with more than a tripling of the risk of SEE, with a stronger association in women than in men. CHA2 DS2-VASc is associated with SEE risk in AF patients, highlighting the value of the score to predict adverse outcomes and guide treatment decisions in people with AF.",

keywords = "Atrial fibrillation, CHA DS-VASc score, Extracranial systemic embolism",

author = "Mengyuan Shi and Chen, {Lin Y.} and Wobo Bekwelem and Norby, {Faye L.} and Soliman, {Elsayed Z.} and Alam, {Aniqa B.} and Alvaro Alonso",

note = "Funding Information: The ARIC study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract nos. (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I). This work was additionally supported by American Heart Association grant 16EIA26410001 (Alonso) and National Heart, Lung, and Blood Institute K24HL148521. Funding Information: The ARIC study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract nos. (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I). This work was additionally supported by American Heart Association grant 16EIA26410001 (Alonso) and National Heart, Lung, and Blood InstituteK24HL148521. Publisher Copyright: {\textcopyright} 2020 The Authors.",

year = "2020",

month = nov,

day = "3",

doi = "10.1161/JAHA.120.016724",

language = "English (US)",

volume = "9",

journal = "Journal of the American Heart Association",

issn = "2047-9980",

publisher = "Wiley-Blackwell",

number = "18",

}

TY - JOUR

T1 - Association of atrial fibrillation with incidence of extracranial systemic embolic events

T2 - The aric study

AU - Shi, Mengyuan

AU - Chen, Lin Y.

AU - Bekwelem, Wobo

AU - Norby, Faye L.

AU - Soliman, Elsayed Z.

AU - Alam, Aniqa B.

AU - Alonso, Alvaro

N1 - Funding Information: The ARIC study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract nos. (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I). This work was additionally supported by American Heart Association grant 16EIA26410001 (Alonso) and National Heart, Lung, and Blood Institute K24HL148521. Funding Information: The ARIC study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract nos. (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I). This work was additionally supported by American Heart Association grant 16EIA26410001 (Alonso) and National Heart, Lung, and Blood InstituteK24HL148521. Publisher Copyright: © 2020 The Authors.

PY - 2020/11/3

Y1 - 2020/11/3

N2 - BACKGROUND: Atrial fibrillation (AF) increases the risk of stroke and extracranial systemic embolic events (SEEs), but little is known about the magnitude of the association of AF with SEE. METHODS AND RESULTS: This analysis included 14 941 participants of the ARIC (Atherosclerosis Risk in Communities) study (mean age, 54.2±5.8, 55% women, 74% White) without AF at baseline (1987–1989) followed through 2017. AF was identified from study ECGs, hospital discharges, and death certificates, while SEEs were ascertained from hospital discharges. CHA2 DS2-VASc was calculated at the time of AF diagnosis. Cox regression was used to estimate associations of incident AF with SEE risk in the entire cohort, and between CHA2 DS2-VASc score and SEE risk in those with AF. Among eligible participants, 3114 participants developed AF and 270 had an SEE (59 events in AF). Incident AF was associated with increased risk of SEE (hazard ratio [HR], 3.58; 95% CI, 2.57–5.00), after adjusting for covariates. The association of incident AF with SEE was stronger in women (HR, 5.26; 95% CI, 3.28–8.44) than in men (HR, 2.68; 95% CI, 1.66–4.32). In those with AF, higher CHA2 DS2-VASc score was associated with increased SEE risk (HR per 1-point increase, 1.24; 95% CI, 1.05–1.47). CONCLUSIONS: AF is associated with more than a tripling of the risk of SEE, with a stronger association in women than in men. CHA2 DS2-VASc is associated with SEE risk in AF patients, highlighting the value of the score to predict adverse outcomes and guide treatment decisions in people with AF.

AB - BACKGROUND: Atrial fibrillation (AF) increases the risk of stroke and extracranial systemic embolic events (SEEs), but little is known about the magnitude of the association of AF with SEE. METHODS AND RESULTS: This analysis included 14 941 participants of the ARIC (Atherosclerosis Risk in Communities) study (mean age, 54.2±5.8, 55% women, 74% White) without AF at baseline (1987–1989) followed through 2017. AF was identified from study ECGs, hospital discharges, and death certificates, while SEEs were ascertained from hospital discharges. CHA2 DS2-VASc was calculated at the time of AF diagnosis. Cox regression was used to estimate associations of incident AF with SEE risk in the entire cohort, and between CHA2 DS2-VASc score and SEE risk in those with AF. Among eligible participants, 3114 participants developed AF and 270 had an SEE (59 events in AF). Incident AF was associated with increased risk of SEE (hazard ratio [HR], 3.58; 95% CI, 2.57–5.00), after adjusting for covariates. The association of incident AF with SEE was stronger in women (HR, 5.26; 95% CI, 3.28–8.44) than in men (HR, 2.68; 95% CI, 1.66–4.32). In those with AF, higher CHA2 DS2-VASc score was associated with increased SEE risk (HR per 1-point increase, 1.24; 95% CI, 1.05–1.47). CONCLUSIONS: AF is associated with more than a tripling of the risk of SEE, with a stronger association in women than in men. CHA2 DS2-VASc is associated with SEE risk in AF patients, highlighting the value of the score to predict adverse outcomes and guide treatment decisions in people with AF.

KW - Atrial fibrillation

KW - CHA DS-VASc score

KW - Extracranial systemic embolism

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DO - 10.1161/JAHA.120.016724

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SN - 2047-9980

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JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

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ER -

Association of atrial fibrillation with incidence of extracranial systemic embolic events: The aric study

Abstract

Bibliographical note

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