Risk of Atrial Fibrillation, Ischemic Stroke and Cognitive Impairment: Study of a Population Cohort ≥65 Years of Age

Figures & data

Table 1 Baseline Characteristics of Cases with AF vs without AF

Variables	NO-AF1	AF1	p	All
All	45,462	1244		46,706
Women (n, %)	24,593 (54.1%)	584 (46.9%)	<0.001
Age average (year)	79,3±10,6	81,02±8,26	<0,001	79,3±10.6
Screening AF^a	24,195 (53.2%)	990 (79.6%)	<0.001	25,185 (53.9%)
Hypertension arterial	25,012 (55,0%)	930 (74.8%)	<0,001	25,942
Diabetes mellitus	9603 (21.1%)	330 (26.5%)	<0,001	9933
Weight average (kg)	75,04±17,0	79,3±16,5	<0,001	75,1±17,0
Heart rate (average/min)	73±10	73±9	0,164	73,7±9,5
Ischemic cardiomyopathy	2727 (6.0%)	156 (12.5%)	<0,001	2883
Peripheral arterial disease	2576 (5.7%)	148 (11.9%)	<0,001	2724
Heart failure	2400 (5.3%)	282 (22.7%)	<0,001	2682
Stroke	208 (0.5%)	26 (2.1%)	<0,001	234
NIHSS score average	4,60±5,6	4,30±6,4	0,820	4,5±5,7
Rankin score average	1,91±1.60	1,87±1,63	0,902	1,9±1,6
Cognitive impairment	3791 (8.3%)	126 (10.1%)	<0,001	3917
Pfeiffer score average	3,73±3,5	2.51±2.8	<0,001	3,6±3,5
CHA2DS2-VASc score average	3.03±1.14	3.64±1,17	<0,001	3.0±1.1
Chronic renal insufficiency	4483 (9.9%)	267 (21.5%)	<0,001	4750
Chronic liver disease	52 (0.1%)	7 (0.6%)	<0,001	59
Charlson score average	1,03±1.20	1,56±1,35	<0,001	1,0±1,2
CCP^b register	1838 (4.0%)	132 (10.6%)	<0,001	1970
Institutionalization	1514 (3.3%)	76 (6.1%)	<0,001	1590
Average number of prescribed drugs	4.73±4.03	7.95±4.18	<0,001	4.8±4.0
Anticoagulation		962 (77.3%)
Statins	12,266 (27,0%)	439 (35.3%)	<0,001	12,705
Average number of visits/year Primary Care (2016)	11,4±13.2	24,16±22,3	<0.001	11.8±13.7
Average number of visits/year Primary Care (2018)	12.2±14.3	34,11±24,0	<0.001	12.7±15.0
Average number of visits/year Hospital/Emergency (2018)	0.26±1.0	0,92±1,90	<0.001	0.28±1.04
Death	20,869 (45.9%)	660 (53.1%)	<0.001	21,529

Notes: ^aAF, atrial fibrillation; ^bCCP, complex and chronic patient.

Table 2 Distribution of Cases According to Calculated AF Risk (N 37,731)

Quartiles AF-Risk1^Citation16	Q1	Q2	Q3	Q4	ALL
MEN
N	6150	4958	4150	1968	17,235
Atrial fibrillation ID/1000/person-years^a	125 7.6 (5.6–8.0)	169 10.2 (8.7–11.9)	210 16.9 (14.7–19.3)	133 22.5 (18.9–26.7)	637 12.3 (11.4–13.3)
NNS^b	49	30	20	15	27
Age average ±SD	70.14±4.1	77.26±6.7	83.7±7.1	88.7±7.6	78.5±10.2
CHA2DS2-VASc (average±SD)	1.80±0.66	2.73±0.66	3.27±0.77	4.02±0.93	2.52±1.05
Weight (Kg average±SD)	77.6±11.3	81.1±13.4	82.0±13.5	88.3±22.7	80.7±15.3
Heart rate (average±SD)	74.2±10.4	72.0±9.2	70.6±8.6	69.3±8.4	72.3±9.8
Ischaemic stroke (n)	14	22	46	31	118
Rankin score average±SD)	1.33±1.15	1.53±1.94	1.75±1.54	2.48±1.63	1.96±1.65
Pfeifer score (average±SD)	1.9±3.0	2.6±3.4	3.0±3.33	3.1±3.4	3.0±3.4
Cognitive impairment (%)	2.5%	5.6%	9.9%	12.1%	6.3%
WOMEN	Q1	Q2	Q3	Q4	ALL
N	3400	4482	5254	7360	20,496
Atrial fibrillation ID/1000/person-years^a	29 2.8 (1.9–4.1)	59 4.4 (33.3–5.7)	124 7.9 (6.5–9.4)	344 15.6 (14.0–17.3)	556 9.0 (8.3–9.8)
NNS^b	117	76	42	21	37
Age average ±SD	68.6±3.0	72.3±5.0	79.3±6.6	87.2±7.4	80.0±10.8
CHA2DS2-VASc (average±SD)	2.31±0.48	3.05±0.57	3.74±0.61	4.45±0.82	3.49±1.03
Weight (kg average±SD)	63.3±9.7	70.2±12.0	70.4±14.0	74.5±21.0	70.4±17.0
Heart rate (average±SD)	77.2±9.7	74.8±8.6	74.9±8.5	73.3±8.0	75.0±9.0
Ischaemic stroke (n)	3	11	13	69	96
Rankin score average±SD)	0.00	0.44±0.72	1.86±1.77	2.15±1.48	1.84±1.55
Pfeifer score (average±SD)	2.5±3.2	2.8±3.5	3.3±3.3	4.0±3.4	4.0±3.5
Cognitive impairment (%)	2.8%	4.6%	10.9%	17.6%	10.6%
ALL	Q1	Q2	Q3	Q4	ALL
N	9550	9440	9413	9328	37,731
Women (%)	35.6%	47.5%	55.8%	78.9%	54.3%
Atrial fibrillation ID/1000/person-years^a	154 5.4 (4.6–6.3)	228 8.1 (7.0–9.2)	334 11.8 (10.6–13.2)	477 17.0 (15.5–18.6)	1193 10.5 (9.9–11.2)
NNS^b	62	41	28	19	31
Age average ±SD	69.6±3.8	74.9±6.4	81.2±7.1	87.5±7.4	79.3±10.6
CHA2DS2-VASc (average±SD)	1.98±0.66	2.88±0.64	3.53±0.72	4.36±0.87	3.04±1.15
Weight (kg average±SD)	72.5±12.7	76.0±14.0	75.5±15.0	77.5±22.0	75.1±17.0
Heart rate (average±SD)	75.3±10.2	73.7±9.0	73.0±8.8	72.4±8.3	73.7±9.5
Ischaemic stroke (n)	17 0.6 (0,33–0,96)	33 1.2 (0.8–1.63)	59 2.1 (1.6–2.7)	105 3.8 (3.1–4.6)	214 1.9 (1.63–2.16)
Rankin score average±SD)	0,66±1,15	1.15±1.69	1.80±1.55	2.27±1.53	1.91±1.60
Pfeifer score (average±SD)	2,13±3.06	2.69±3.43	3.18±3.34	3.86±3.42	3.68±3.52
Cognitive impairment (%)	248 (2.6%)	485 (5.1%)	986 (10.5%)	1531 (16.4%)	3250 (8.6%)

Notes: ^aIncidence rate: 1000/person-years; ^bNNS: number needed to screen to detect one case of AF.

Table 3 Baseline Characteristics of Stroke vs Non-Stroke Cases

Variables	Stroke	Non-Stroke	p
All	234	46,472
Women (n,%) Men (n,%)	101 (43.16%) 133 (56.8%)
Age average (year)	79,7±8.44	79.3±10.62	0.606
Atrial fibrillation	26 (11.1%)	1218 (2.6%)	<0.001
Screening AF^a	170 (72.6%)	25,015 (53.8%)	<0.001
Hypertension arterial	179 (76.5%)	25,763 (55.4%)	<0.001
Diabetes mellitus	76 (32.5%)	9857 (21.2%)	<0.001
Weight average (kg)	76,32±13.4	75.16±17.0	0.316
Heart rate (average/min)	73±10	73±9	0.154
Ischemic cardiomyopathy	17 (7.3%)	2866 (6.2%)	0.279
Peripheral arterial disease	23 (9.8%)	2701 (5.8%)	0.010
Heart Failure	24 (10.3%)	2658 (5.7%)	<0.001
Cognitive impairment	36 (15.4%)	3881 (8.4%)	<0.001
Pfeiffer score (average)	3.22±2.81	3,7±3.52	0.301
CHA2DS2-VASc score (average)	4.44±1.13	3.04±1,14	<0.001
Chronic renal insufficiency	36 (15.4%)	4714 (10.1%)	<0.001
Chronic liver disease	0	59 (0.1%)	0.743
Charlson score (average)	2.4±1.36	1.03±1.21	<0.001
CCP^b	28 (12%)	1942 (4.2%)	<0.001
Institutionalization	23 (9.8%)	1567 (3.4%)	<0.001
Average number of prescribed drugs	7.47±4.34	4.80±4.06	<0.001
Statins prescription	129 (55.1%)	12,576 (27.1%)	<0.001
Average number of visits/year Primary Care (2016)	19.32±17.1	11.77±13.72	<0.001
Average number of visits/year Primary Care (2018)	23.07±21.14	12.72±15.02	<0.001
Average number of visits/year Hospital/Emergency (2018)	1.22±1.75	0.27±1.04	<0.001
Death	196 (83.8%)	36,274 (78.1%)	0.042

Notes: ^aPeople with opportunistic screening AF; ^bCCP, complex and chronic patient.

Figure 1 Atrial fibrillation Primary Care Pathway (proposal).

Muria-Subirats E, Clua-Espuny JL, Ballesta-Ors J, Lorman-Carbó B, Lechuga-Durán I, Fernández-Sáez J. Pla-Farnós R. Incidence and Risk Assessment for Atrial Fibrillation at 5 Years: hypertensive Diabetic Retrospective Cohort. Int J Environ Res. 2020;17(10):3491. doi:10.3390/ijerph17103491

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