"Risk assessment tools are designed for individuals without previous cardiovascular disease, and the calculations may not apply to patients with established cardiovascular disease. Socioeconomic status is perhaps a better marker to assess risk of future events in heart attack patients, and more research is needed to determine other factors that could be included, such as occupation or residential area," said Dr Ohm.
Alcohol-Related Hospitalization Associated With Doubled Stroke Risk in Atrial Fibrillation
Alcohol-related hospitalization is associated with a doubled risk of ischemic stroke in patients with nonvalvular atrial fibrillation (AF), according to research presented by Faris Al-Khalili, MD, PhD, a cardiologist at the Karolinska Institute Danderyd Hospital in Stockholm. The observational study was conducted in more than 25,000 patients with nonvalvular AF at low risk of stroke.
"AF is the most common heart rhythm disturbance and is associated with a fivefold ncreased risk of ischemic stroke," said Dr. Al-Khalili. "AF is also associated with increased mortality, reduced quality of life, and a higher risk of heart failure."
Treatment with oral anticoagulants reduces the risk of stroke and is recommended according to the patient's number of stroke risk factors. Risk is estimated using the CHA2DS2-VASc score, which gives points for clinical risk factors. Patients with nonvalvular AF under age 65 who have a score of zero (in men) or one (in women) are considered to be at low risk for ischemic stroke, and oral anticoagulation therapy is not indicated for them.
"Even if the risk for stroke is low, it is not negligible, and a number of such low-risk patients do present with ischemic stroke in clinical practice and in patient registers," said Dr. Al-Khalili.
The objective of this study was to assess the incidence and predictors of ischemic stroke among low-risk patients with nonvalvular AF. This retrospective study included 25,252 patients (ages 18 to 64) of a total of 34,523 patients with AF identified from the Swedish nationwide patient register for the period between January 1, 2006 and December 31, 2012. The median age was 55, and 72% of participants were men.
Information was available regarding all hospitalizations and visits to hospital-affiliated open clinics in Sweden. Socioeconomic variables were obtained from a database for health insurance and labor market studies. Information about current medication was obtained from the National Drug Register, which has information about all dispensed prescription in Sweden and is 100% complete.
During a median follow-up of five years, ischemic stroke occurred at an annual rate of 3.4 per 1,000 patient-years. The overall mortality was 7.5 per 1,000 patient-years in patients without ischemic stroke and 29.6 per 1,000 patient-years in patients who had had an ischemic stroke during follow-up.
In the multivariable analysis, the only variables that remained significantly associated with an increased risk of ischemic stroke were age (hazard ratio [HR], 1.06) and alcohol-related hospitalization (HR, 2.01). Use of oral anticoagulants was associated with a lower risk of ischemic stroke (HR, 0.78).
"Even though these patients are classified as low-risk, the incidence of ischemic stroke in our study population is neither negligible nor ignorable, and it carries a relatively high mortality," said Dr. Al-Khalili.