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. 2018 May 9:361:k1717.
doi: 10.1136/bmj.k1717.

Risk of stroke and transient ischaemic attack in patients with a diagnosis of resolved atrial fibrillation: retrospective cohort studies

Nicola J Adderley  1 , Krishnarajah Nirantharakumar  2 , Tom Marshall  1
Affiliations

Risk of stroke and transient ischaemic attack in patients with a diagnosis of resolved atrial fibrillation: retrospective cohort studies

Nicola J Adderley et al. BMJ. .

Abstract

Objectives: To determine rates of stroke or transient ischaemic attack (TIA) and all cause mortality in patients with a diagnosis of "resolved" atrial fibrillation compared to patients with unresolved atrial fibrillation and without atrial fibrillation.

Design: Two retrospective cohort studies.

Setting: General practices contributing to The Health Improvement Network, 1 January 2000 to 15 May 2016.

Participants: Adults aged 18 years or more with no previous stroke or TIA: 11 159 with resolved atrial fibrillation, 15 059 controls with atrial fibrillation, and 22 266 controls without atrial fibrillation.

Main outcome measures: Primary outcome was incidence of stroke or TIA. Secondary outcome was all cause mortality.

Results: Adjusted incidence rate ratios for stroke or TIA in patients with resolved atrial fibrillation were 0.76 (95% confidence interval 0.67 to 0.85, P<0.001) versus controls with atrial fibrillation and 1.63 (1.46 to 1.83, P<0.001) versus controls without atrial fibrillation. Adjusted incidence rate ratios for mortality in patients with resolved atrial fibrillation were 0.60 (0.56 to 0.65, P<0.001) versus controls with atrial fibrillation and 1.13 (1.06 to 1.21, P<0.001) versus controls without atrial fibrillation. When patients with resolved atrial fibrillation and documented recurrent atrial fibrillation were excluded the adjusted incidence rate ratio for stroke or TIA was 1.45 (1.26 to 1.67, P<0.001) versus controls without atrial fibrillation.

Conclusion: Patients with resolved atrial fibrillation remain at higher risk of stroke or TIA than patients without atrial fibrillation. 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.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/coi_disclosure.pdf and declare: NA and TM report a grant from the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West Midlands during the conduct of the study; KN reports personal fees from Sanofi, and grants from AstraZeneca, Health Data Research UK (Medical Research Council) and British Heart Foundation, outside the submitted work; authors declare no other financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1
Fig 1
Proportion of patients with atrial fibrillation with a record of atrial fibrillation resolved from 2000 to 2016
Fig 2
Fig 2
Unadjusted Nelson-Aalen cumulative hazard estimates for stroke or transient ischaemic attack (TIA) in patients with resolved atrial fibrillation versus unresolved atrial fibrillation; mortality in patients with resolved atrial fibrillation versus unresolved atrial fibrillation; stroke or TIA in patients with resolved atrial fibrillation versus no atrial fibrillation; mortality in patients with resolved atrial fibrillation versus no atrial fibrillation (see supplementary figure 1 for adjusted cumulative hazard estimates)
See this image and copyright information in PMC

Comment in

  • Nach VF lebenslang antikoagulieren.
    Holzgreve H. Holzgreve H. MMW Fortschr Med. 2018 Jul;160(13):30. doi: 10.1007/s15006-018-0758-8. MMW Fortschr Med. 2018. PMID: 30014403 German. No abstract available.

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