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J Epidemiol. 2017 Aug;27(8):360-367. doi: 10.1016/j.je.2016.08.012. Epub 2017 Apr 5.

Risk of stroke and heart failure attributable to atrial fibrillation in middle-aged and elderly people: Results from a five-year prospective cohort study of Japanese community dwellers.

Author information

1
Department of Internal Medicine, Iwate Medical University, Morioka, Japan; Department of Internal Medicine, Morioka Tsunagi Onsen Hospital, Morioka, Japan. Electronic address: m-ohsawa@k2.dion.ne.jp.
2
Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan.
3
Department of Hygiene and Preventive Medicine, Iwate Medical University, Yahaba-cho, Iwate, Japan.
4
Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
5
Department of Nutritional Sciences, Morioka University, Takizawa, Iwate, Japan.
6
Department of Internal Medicine, Morioka Tsunagi Onsen Hospital, Morioka, Japan.
7
Department of Clinical Nursing, Shiga University of Medical Science, Otsu, Japan.
8
Department of Community Health Sciences, University of Calgary, Calgary, Canada.
9
Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
10
Department of Health and Physical Education, Faculty of Education, Iwate University, Morioka, Japan.
11
Iwate Health Service Association, Morioka, Japan.
12
The Research Institute of Strategy for Prevention, Tokyo, Japan.

Abstract

BACKGROUND:

The relative and absolute risks of stroke and heart failure attributable to atrial fibrillation (AF) have not been sufficiently examined.

METHODS:

A prospective study of 23,731 community-dwelling Japanese individuals was conducted. Participants were divided into two groups based on the presence or absence of prevalent AF (n = 338 and n = 23,393, respectively). Excess events (EE) due to AF and relative risks (RRs) determined using the non-AF group as the reference for incident stroke and heart failure were estimated using Poisson regression stratified by age groups (middle-aged: 40-69 years old; elderly: 70 years of age or older) after adjustment for sex and age.

RESULTS:

There were 611 cases of stroke and 98 cases of heart failure during the observation period (131,088 person-years). AF contributed to a higher risk of stroke both in middle-aged individuals (EE 10.4 per 1000 person-years; RR 4.88; 95% confidence interval [CI], 2.88-8.29) and elderly individuals (EE 18.3 per 1000 person-years; RR 3.05; 95% CI, 2.05-4.54). AF also contributed to a higher risk of heart failure in middle-aged individuals (EE 3.7 per 1000 person-years; RR 8.18; 95% CI, 2.41-27.8) and elderly individuals (EE 15.4 per 1000 person-years; RR 7.82; 95% CI, 4.11-14.9). Results obtained from multivariate-adjusted analysis were similar (stroke: EE 8.9 per 1000 person-years; RR 4.40; 95% CI, 2.57-7.55 in middle-aged and EE 17.4 per 1000 person-years; RR 2.97; 95% CI, 1.99-4.43 in elderly individuals; heart failure: EE 3.1 per 1000 person-years; RR 7.22; 95% CI, 2.06-25.3 in middle-aged and EE 14.1 per 1000 person-years; RR 7.41; 95% CI, 3.86-14.2 in elderly individuals).

CONCLUSIONS:

AF increased the risk of stroke by the same magnitude as that reported previously in Western countries. AF increased the RR of heart failure more than that in Western populations.

KEYWORDS:

Absolute risk; Atrial fibrillation; Heart failure; Prospective study; Relative risk; Stroke

PMID:
28390793
PMCID:
PMC5549250
DOI:
10.1016/j.je.2016.08.012
[Indexed for MEDLINE]
Free PMC Article

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