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

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorGOULART, Alessandra C.
dc.contributor.authorOLMOS, Rodrigo Diaz
dc.contributor.authorSANTOS, Itamar S.
dc.contributor.authorTUNES, Gisela
dc.contributor.authorALENCAR, Airlane P.
dc.contributor.authorTHOMAS, Neil
dc.contributor.authorLIP, Gregory Y. H.
dc.contributor.authorLOTUFO, Paulo A.
dc.contributor.authorBENSENOR, Isabela M.
dc.date.accessioned2022-02-24T17:13:22Z
dc.date.available2022-02-24T17:13:22Z
dc.date.issued2022
dc.description.abstractBackground Atrial fibrillation is a predictor of poor prognosis after stroke. Aims 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. Methods 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. Results 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) vs. non-atrial fibrillation (1808, IQR: 334-3301), p-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, p = 0.002) and stroke mortality (oral anticoagulant time-dependent effect >= 6 months: multivariable OR, 0.09; 95% CI: 0.01-0.65, p-value = 0.02), but not cardiovascular mortality. Conclusions 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.eng
dc.description.indexMEDLINEeng
dc.description.sponsorshipSao Paulo Research Support Foundation of the State of Sao Paulo (FAPESP)Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP) [2018/05512-3]
dc.identifier.citationINTERNATIONAL JOURNAL OF STROKE, v.17, n.1, p.48-58, 2022
dc.identifier.doi10.1177/1747493021995592
dc.identifier.eissn1747-4949
dc.identifier.issn1747-4930
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/44333
dc.language.isoeng
dc.publisherSAGE PUBLICATIONS LTDeng
dc.relation.ispartofInternational Journal of Stroke
dc.rightsrestrictedAccesseng
dc.rights.holderCopyright SAGE PUBLICATIONS LTDeng
dc.subjectStroke epidemiologyeng
dc.subjectstroke in developing countrieseng
dc.subjectstroke preventioneng
dc.subject.otherimmortal time biaseng
dc.subject.otherischemic-strokeeng
dc.subject.othercumulative incidenceeng
dc.subject.otherriskeng
dc.subject.othersurvivaleng
dc.subject.othertherapyeng
dc.subject.othercohorteng
dc.subject.wosClinical Neurologyeng
dc.subject.wosPeripheral Vascular Diseaseeng
dc.titleThe 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 Morbidityeng
dc.typearticleeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng
dspace.entity.typePublication
hcfmusp.affiliation.countryInglaterra
hcfmusp.affiliation.countryDinamarca
hcfmusp.affiliation.countryisogb
hcfmusp.affiliation.countryisodk
hcfmusp.author.externalTUNES, Gisela:Univ Sao Paulo, Inst Math & Stat, Sao Paulo, Brazil
hcfmusp.author.externalALENCAR, Airlane P.:Univ Sao Paulo, Inst Math & Stat, Sao Paulo, Brazil
hcfmusp.author.externalTHOMAS, Neil:Univ Birmingham, Inst Appl Hlth Res, Birmingham, W Midlands, England
hcfmusp.author.externalLIP, Gregory Y. H.:Univ Liverpool, Liverpool Ctr Cardiovasc Sci, Liverpool, Merseyside, England; Liverpool Heart & Chest Hosp, Liverpool, Merseyside, England; Aalborg Univ, Dept Clin Med, Aalborg Thrombosis Res Unit, Aalborg, Denmark
hcfmusp.citation.scopus13
hcfmusp.contributor.author-fmusphcALESSANDRA CARVALHO GOULART
hcfmusp.contributor.author-fmusphcRODRIGO DIAZ OLMOS
hcfmusp.contributor.author-fmusphcITAMAR DE SOUZA SANTOS
hcfmusp.contributor.author-fmusphcPAULO ANDRADE LOTUFO
hcfmusp.contributor.author-fmusphcISABELA JUDITH MARTINS BENSEñOR
hcfmusp.description.articlenumber1747493021995590
hcfmusp.description.beginpage48
hcfmusp.description.endpage58
hcfmusp.description.issue1
hcfmusp.description.volume17
hcfmusp.origemWOS
hcfmusp.origem.pubmed33527882
hcfmusp.origem.scopus2-s2.0-85101823094
hcfmusp.origem.wosWOS:000627525900001
hcfmusp.publisher.cityLONDONeng
hcfmusp.publisher.countryENGLANDeng
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