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Ann Epidemiol. 2013 Mar;23(3):112-8. doi: 10.1016/j.annepidem.2012.12.011. Epub 2013 Jan 16.

Atrial fibrillation and risk of stroke in dialysis patients.

Author information

1
Department of Medicine, Division of Nephrology and Hypertension, University of Kansas School of Medicine, Kansas City, KS, USA. jwetmore@kumc.edu

Abstract

PURPOSE:

Both stroke and chronic atrial fibrillation (AF) are common in dialysis patients, but uncertainty exists in the incidence of new strokes and the risk conferred by chronic AF.

METHODS:

A cohort of dually eligible (Medicare and Medicaid) incident dialysis patients was constructed. Medicare claims were used to determine the onset of chronic AF, which was specifically treated as a time-dependent covariate. Cox proportional hazards models were used to model time to stroke.

RESULTS:

Of 56,734 patients studied, 5629 (9.9%) developed chronic AF. There were 22.8 ischemic and 5.0 hemorrhagic strokes per 1000 patient-years, a ratio of approximately 4.5:1. Chronic AF was independently associated with time to ischemic (hazard ratio [HR], 1.26; 99% confidence interval [CI], 1.06-1.49; P = .0005), but not hemorrhagic, stroke. Race was strongly associated with hemorrhagic stroke: African Americans (HR, 1.46; 99% CI, 1.08-1.96), Hispanics (HR, 1.64; 99% CI, 1.16-2.31), and others (HR, 1.76; 99% CI, 1.16-2.78) had higher rates than did Caucasians (all P < .001).

CONCLUSIONS:

Chronic AF has a significant, but modest, association with ischemic stroke. Race/ethnicity is strongly associated with hemorrhagic strokes. The proportion of strokes owing to hemorrhage is much higher than in the general population.

PMID:
23332588
PMCID:
PMC3570646
DOI:
10.1016/j.annepidem.2012.12.011
[Indexed for MEDLINE]
Free PMC Article
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