Per Wändell1,2, Axel C Carlsson1,3, Martin J Holzmann4,5, Johan Ärnlöv3,6, Sven-Erik Johansson7, Jan Sundquist7, Kristina Sundquist7. 1. a Division of Family Medicine, Department of Neurobiology, Care Science and Society , Karolinska Institutet , Huddinge , Sweden. 2. b Academic Primary Healthcare Centre, Stockholm County Council , Huddinge , Sweden. 3. c Department of Medical Sciences , Cardiovascular Epidemiology, Uppsala University , Uppsala , Sweden. 4. d Department of Emergency Medicine , Karolinska University Hospital , Stockholm , Sweden. 5. e Department of Internal Medicine , Karolinska Institutet , Stockholm , Sweden. 6. f School of Health and Social Studies , Dalarna University , Falun , Sweden. 7. g Center for Primary Health Care Research, Lund University , Malmö , Sweden.
Abstract
OBJECTIVE: Our aim was to study the risk of a first ischaemic stroke (IS) in patients with atrial fibrillation (AF) treated in primary healthcare. DESIGN: The study population included all adults (n = 11,517), 45 years and older diagnosed with AF, from 75 primary care centres in Sweden between 2001 and 2007. IS was defined as a hospital care event of stroke between 2001 and 2010. Association between incident stroke and warfarin treatment was explored using Cox regression analysis, with hazard ratios (HRs), and 95% confidence intervals (95%CIs). Adjustment was made for age, socioeconomic factors and co-morbidity. RESULTS: Persistent treatment with warfarin was present among 33.7% of women and 40.0% among men. Persistent warfarin treatment, compared to no persistent treatment, was associated with a stroke preventing effect with fully adjusted HRs of 0.25 (95%CI 0.18-0.36) in women, and 0.25 (95%CI 0.19-0.32) in men. A CHA2DS2-VASc score of at least two among women, and three among men, was associated with a stroke risk exceeding 18% during a mean follow-up of 5.4 years. Risk of haemorrhagic stroke was not increased. CONCLUSIONS: Warfarin is effective in preventing stroke in AF patients in primary healthcare.
OBJECTIVE: Our aim was to study the risk of a first ischaemic stroke (IS) in patients with atrial fibrillation (AF) treated in primary healthcare. DESIGN: The study population included all adults (n = 11,517), 45 years and older diagnosed with AF, from 75 primary care centres in Sweden between 2001 and 2007. IS was defined as a hospital care event of stroke between 2001 and 2010. Association between incident stroke and warfarin treatment was explored using Cox regression analysis, with hazard ratios (HRs), and 95% confidence intervals (95%CIs). Adjustment was made for age, socioeconomic factors and co-morbidity. RESULTS: Persistent treatment with warfarin was present among 33.7% of women and 40.0% among men. Persistent warfarin treatment, compared to no persistent treatment, was associated with a stroke preventing effect with fully adjusted HRs of 0.25 (95%CI 0.18-0.36) in women, and 0.25 (95%CI 0.19-0.32) in men. A CHA2DS2-VASc score of at least two among women, and three among men, was associated with a stroke risk exceeding 18% during a mean follow-up of 5.4 years. Risk of haemorrhagic stroke was not increased. CONCLUSIONS:Warfarin is effective in preventing stroke in AFpatients in primary healthcare.
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