Stroke, TIA Risk Remain High After Atrial Fibrillation Resolved

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Patients with resolved AF have a greater risk for stroke or TIA than those without AF.
Patients with resolved AF have a greater risk for stroke or TIA than those without AF.

Patients with resolved atrial fibrillation have an increased risk for stroke or transient ischemic attack (TIA) compared with individuals without atrial fibrillation, according to a study published in the BMJ. 

Nicola J. Adderley, a research fellow at the Institute of Applied Health Research at the University of Birmingham, UK, and associates conducted 2 retrospective group analyses to observe stroke or TIA events and all-cause mortality in patients with diagnosed resolved atrial fibrillation compared to patients with unresolved atrial fibrillation and individuals without atrial fibrillation. 

Patients older than 18 years with no prior stroke or TIA were eligible for participation; 11,159 individuals had resolved atrial fibrillation, 15,059 had unresolved atrial fibrillation, and 22,266 volunteers had no atrial fibrillation. 

The main outcome measured was stroke or TIA occurrence, while the secondary outcome measured was all-cause mortality. 

When adjusted, resolved atrial fibrillation incidence rate ratios were 0.76 and 1.63 when compared with unresolved and no atrial fibrillation, respectively. For mortality, incidence rate ratios were 0.60 and 1.13 for resolved patients compared with unresolved and no atrial fibrillation controls, respectively. Excluding resolved or documented atrial fibrillation, recurrent atrial fibrillation resulted in an incidence rate ratio of 1.45 for stroke or TIA when compared with those without atrial fibrillation. 

“Patients with resolved atrial fibrillation remain at higher risk of stroke or TIA than patients without atrial fibrillation,” the authors reported. “The risk is increased even in those in whom recurrent atrial fibrillation is not documented. Guidelines should be updated to advocate continued use of anticoagulants in patients with resolved atrial fibrillation.”

Reference

Adderley NJ, Nirantharakumar K, Marshall T. Risk of stroke and transient ischemic attack in patients with a diagnosis of resolved atrial fibrillation: retrospective cohort studies. BMJ. 2018; 361:k1717


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