Zhih-Cherng Chen1,2, Nan-Chun Wu3,4, Chia-Li Chang5, Chung-Han Ho4,5, Chia-Te Liao1, Chun-Yen Chiang1,2, Wei-Ting Chang1,6,7. 1. Department of Cardiology, Chi Mei Medical Center, Tainan, Taiwan. 2. Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan. 3. Department of Cardiovascular Surgery, Chi Mei Medical Center, Tainan, Taiwan. 4. Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan. 5. Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan. 6. Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan. 7. Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Abstract
OBJECTIVE: Atrial fibrillation (AF) is the most common cardiac complication of thyrotoxicosis and is strongly implicated in thromboembolic events. However, the incidence of stroke in thyrotoxic AF remains unclear. Herein, we aimed to investigate the risks of mortality and ischaemic stroke between patients with thyrotoxic AF and nonthyrotoxic AF. DESIGNS AND METHODS: From Taiwan's National Health Insurance Research Database, 1868 patients with the concomitant diagnoses of AF and thyrotoxicosis identified between 2001 and 2010 were compared to 7472 patients with nonthyrotoxic AF using propensity score matching for age, sex and comorbidities. RESULTS: There was no significant difference in either CHA2 DS2 -VASc score or anticoagulant usage between the groups. Alternatively, the thyrotoxic group contained more β-blocker/digoxin users, whereas the nonthyrotoxic group contained more statin users. Patients with thyrotoxic AF exhibited lower risks of all-cause mortality (HR: 0.66, CI: 0.59-0.73, P < .0001) and ischaemic stroke (HR: 0.73, CI: 0.64-0.84, P < .0001) than those with nonthyrotoxic AF, especially thyrotoxic patients with CHA2 DS2 -VASc scores ≥1. Comorbidities, including diabetes, hyperlipidaemia, hypertension and coronary artery disease, contributed to all-cause mortality in patients with nonthyrotoxic AF; however, this effect was diminished in thyrotoxic AF. CONCLUSIONS: Patients with thyrotoxicosis and AF have a lower risk of stroke than patients with nonthyrotoxic AF. Treatment for thyrotoxicosis is also crucial as the prescription of anticoagulants based on CHA2DS2-VASc scores.
OBJECTIVE:Atrial fibrillation (AF) is the most common cardiac complication of thyrotoxicosis and is strongly implicated in thromboembolic events. However, the incidence of stroke in thyrotoxic AF remains unclear. Herein, we aimed to investigate the risks of mortality and ischaemic stroke between patients with thyrotoxic AF and nonthyrotoxic AF. DESIGNS AND METHODS: From Taiwan's National Health Insurance Research Database, 1868 patients with the concomitant diagnoses of AF and thyrotoxicosis identified between 2001 and 2010 were compared to 7472 patients with nonthyrotoxic AF using propensity score matching for age, sex and comorbidities. RESULTS: There was no significant difference in either CHA2 DS2 -VASc score or anticoagulant usage between the groups. Alternatively, the thyrotoxic group contained more β-blocker/digoxin users, whereas the nonthyrotoxic group contained more statin users. Patients with thyrotoxic AF exhibited lower risks of all-cause mortality (HR: 0.66, CI: 0.59-0.73, P < .0001) and ischaemic stroke (HR: 0.73, CI: 0.64-0.84, P < .0001) than those with nonthyrotoxic AF, especially thyrotoxicpatients with CHA2 DS2 -VASc scores ≥1. Comorbidities, including diabetes, hyperlipidaemia, hypertension and coronary artery disease, contributed to all-cause mortality in patients with nonthyrotoxic AF; however, this effect was diminished in thyrotoxic AF. CONCLUSIONS:Patients with thyrotoxicosis and AF have a lower risk of stroke than patients with nonthyrotoxic AF. Treatment for thyrotoxicosis is also crucial as the prescription of anticoagulants based on CHA2DS2-VASc scores.