The impact of atrial fibrillation and long-term oral anticoagulant use on all-cause and cardiovascular mortality: A 12-year evaluation of the prospective Brazilian Study of Stroke Mortality and Morbidity

Goulart, Alessandra C, Olmos, Rodrigo Diaz, Santos, Itamar S, Tunes, Gisela, Alencar, Airlane P, Thomas, Neil, Lip, Gregory YH ORCID: 0000-0002-7566-1626, Lotufo, Paulo A and Bensenor, Isabela M (2022) The impact of atrial fibrillation and long-term oral anticoagulant use on all-cause and cardiovascular mortality: A 12-year evaluation of the prospective Brazilian Study of Stroke Mortality and Morbidity. INTERNATIONAL JOURNAL OF STROKE, 17 (1). pp. 48-58.

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Official URL: http://dx.doi.org/10.1177/1747493021995592

Abstract

<h4>Background</h4>Atrial fibrillation is a predictor of poor prognosis after stroke.<h4>Aims</h4>To evaluate atrial fibrillation and all-cause and cardiovascular mortality in a stroke cohort with low socioeconomic status, taking into consideration oral anticoagulant use during 12-year follow-up.<h4>Methods</h4>All-cause mortality was analyzed by Kaplan-Meier survival curve and Cox regression models to estimate hazard ratios and 95% confidence intervals (95% CI). For specific mortality causes, cumulative incidence functions were computed. A logit link function was used to calculate odds ratios (OR) with 95% CIs. Full models were adjusted by age, sex, oral anticoagulant use (as a time-dependent variable) and cardiovascular risk factors.<h4>Results</h4>Of 1121 ischemic stroke participants, 17.8% had atrial fibrillation. Overall, 654 deaths (58.3%) were observed. Survival rate was lower (median days, interquartile range-IQR) among those with atrial fibrillation (531, IQR: 46-2039) <i>vs</i>. non-atrial fibrillation (1808, IQR: 334-3301), <i>p</i>-log rank < 0.0001). Over 12-year follow-up, previous atrial fibrillation was associated with increased mortality: all-cause (multivariable hazard ratios, 1.82; 95% CI: 1.43-2.31) and cardiovascular mortality (multivariable OR, 2.07; 95% CI: 1.36-3.14), but not stroke mortality. In the same multivariable models, oral anticoagulant use was inversely associated with all-cause mortality (oral anticoagulant time-dependent effect: multivariable hazard ratios, 0.47; 95% CI: 0.30-0.50, <i>p</i> = 0.002) and stroke mortality (oral anticoagulant time-dependent effect ≥ 6 months: multivariable OR, 0.09; 95% CI: 0.01-0.65, <i>p</i>-value = 0.02), but not cardiovascular mortality.<h4>Conclusions</h4>Among individuals with low socioeconomic status, atrial fibrillation was an independent predictor of poor survival, increasing all-cause and cardiovascular mortality risk. Long-term oral anticoagulant use was associated with a markedly reduced risk of all-cause and stroke mortality.

Item Type:	Article
Uncontrolled Keywords:	Stroke epidemiology, stroke in developing countries, stroke prevention
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	10 Oct 2023 15:58
Last Modified:	10 Oct 2023 15:58
DOI:	10.1177/1747493021995592
Open Access URL:	http://pure-oai.bham.ac.uk/ws/files/133824244/ID_I...
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3173596