Aims: We sought to determine whether the incidence of and survival following congestive heart failure(CHF) in patients with atrial fibrillation(AF) have changed over time. Methods and results: Olmsted County, Minnesot...Aims: We sought to determine whether the incidence of and survival following congestive heart failure(CHF) in patients with atrial fibrillation(AF) have changed over time. Methods and results: Olmsted County, Minnesota residents diagnosed with first AF during 1980-2000 were identified and followed in medical records to 2004. The trends of incidence and survival of CHF over time were assessed. Of the 3288 subjects(mean age 71±15 years) diagnosed with first AF and without CHF prior to or at AF diagnosis, 790(24%) developed a first CHF during a mean follow-up of 6.1±5.2 years(unadjusted incidence, 44 per 1000 person years). Age-and sex-adjusted CHF incidence was unrelated to calendar year of AF diagnosis(P=0.86). The age-and sex-adjusted mortality risk following CHF was higher than that in patients without CHF(hazard ratio 3.4, 95%confidence interval 3.1-3.8, P< 0.0001). There were no detectable changes over time with respect to the absolute(P=0.94) or the relative(P=0.68) mortality risk after CHF diagnosis. Conclusion: In this study spanning two decades, there appeared to have been no significant reduction in terms of the incidence and mortality risk of CHF following first AF diagnosis.展开更多
Background and Purpose -With the changes in management of atrial fibrillation (AF) over time, it is possible that the time trends of post-AF stroke incidenc e and mortality have changed. We sought to determine whether...Background and Purpose -With the changes in management of atrial fibrillation (AF) over time, it is possible that the time trends of post-AF stroke incidenc e and mortality have changed. We sought to determine whether the incidence and survival of ischemic stroke after AF diagnosis have improved. Methods -We identified the Olmsted County, Minn, residents who developed first AF from 1980 to 2000 and followed them in medical records to 2004. The outcomes were first ischemic stroke and death. Results -Of the 4117 subjects diagnosed with first AF and without previous stroke, 446 (11%) sustained a first ischemic stroke during a mea n follow-up time of 5.5±5.0 years. The age-and sex-adjusted incidence of str oke decreased, on average, by 3.4%per year (P=0.0001), concurrent with an increase in warfarin and aspirin use (both P < 0.0001) and reduction of systolic blood pressure (P < 0.001). The age-adjusted ischemic stroke incidence was higher in women (P=0.039), but not after adjusting for systolic blood pressure (P=0.41). Compared with the general Minnesota white population, the relative mortality hazard ratio was 1.88 for men and 1.84 for women without stroke and 3.03 for men and 3.80 for women (P < 0.05)with stroke. The relative mortality hazard did not vary by age or calendar year of AF diagnosis. Conclusions -Post-AF ischemic stroke incidence decreased significantly from 1980 to 2000, during which time a substantial increase in the use of antithrombotic therapy and reduction of systolic blood pressure was evident. The relative mortality risk of stroke, however, had not improved over time.展开更多
文摘Aims: We sought to determine whether the incidence of and survival following congestive heart failure(CHF) in patients with atrial fibrillation(AF) have changed over time. Methods and results: Olmsted County, Minnesota residents diagnosed with first AF during 1980-2000 were identified and followed in medical records to 2004. The trends of incidence and survival of CHF over time were assessed. Of the 3288 subjects(mean age 71±15 years) diagnosed with first AF and without CHF prior to or at AF diagnosis, 790(24%) developed a first CHF during a mean follow-up of 6.1±5.2 years(unadjusted incidence, 44 per 1000 person years). Age-and sex-adjusted CHF incidence was unrelated to calendar year of AF diagnosis(P=0.86). The age-and sex-adjusted mortality risk following CHF was higher than that in patients without CHF(hazard ratio 3.4, 95%confidence interval 3.1-3.8, P< 0.0001). There were no detectable changes over time with respect to the absolute(P=0.94) or the relative(P=0.68) mortality risk after CHF diagnosis. Conclusion: In this study spanning two decades, there appeared to have been no significant reduction in terms of the incidence and mortality risk of CHF following first AF diagnosis.
文摘Background and Purpose -With the changes in management of atrial fibrillation (AF) over time, it is possible that the time trends of post-AF stroke incidenc e and mortality have changed. We sought to determine whether the incidence and survival of ischemic stroke after AF diagnosis have improved. Methods -We identified the Olmsted County, Minn, residents who developed first AF from 1980 to 2000 and followed them in medical records to 2004. The outcomes were first ischemic stroke and death. Results -Of the 4117 subjects diagnosed with first AF and without previous stroke, 446 (11%) sustained a first ischemic stroke during a mea n follow-up time of 5.5±5.0 years. The age-and sex-adjusted incidence of str oke decreased, on average, by 3.4%per year (P=0.0001), concurrent with an increase in warfarin and aspirin use (both P < 0.0001) and reduction of systolic blood pressure (P < 0.001). The age-adjusted ischemic stroke incidence was higher in women (P=0.039), but not after adjusting for systolic blood pressure (P=0.41). Compared with the general Minnesota white population, the relative mortality hazard ratio was 1.88 for men and 1.84 for women without stroke and 3.03 for men and 3.80 for women (P < 0.05)with stroke. The relative mortality hazard did not vary by age or calendar year of AF diagnosis. Conclusions -Post-AF ischemic stroke incidence decreased significantly from 1980 to 2000, during which time a substantial increase in the use of antithrombotic therapy and reduction of systolic blood pressure was evident. The relative mortality risk of stroke, however, had not improved over time.
