Risk of Atrial Fibrillation, Ischemic Stroke and Cognitive Impairment: Study of a Population Cohort ≥65 Years of Age

Vasc Health Risk Manag. 2020 Oct 28;16:445-454. doi: 10.2147/VHRM.S276477. eCollection 2020.


Purpose: To evaluate a model for calculating the risk of AF and its relationship with the incidence of ischemic stroke and prevalence of cognitive decline.

Materials and methods: It was a multicenter, observational, retrospective, community-based study of a cohort of general population ≥6ct 35 years, between 01/01/2016 and 31/12/2018. Setting: Primary Care. Participants: 46,706 people ≥65 years with an active medical history in any of the primary care teams of the territory, information accessible through shared history and without previous known AF. Interventions: The model to stratify the risk of AF (PI) has been previously published and included the variables sex, age, mean heart rate, mean weight and CHA2DS2VASc score. Main measurements: For each risk group, the incidence density/1000 person/years of AF and stroke, number of cases required to detect a new AF, the prevalence of cognitive decline, Kendall correlation, and ROC curve were calculated.

Results: The prognostic index was obtained in 37,731 cases (80.8%) from lowest (Q1) to highest risk (Q4). A total of 1244 new AFs and 234 stroke episodes were diagnosed. Q3-4 included 53.8% of all AF and 69.5% of strokes in men; 84.2% of all AF and 85.4% of strokes in women; and 77.4% of cases of cognitive impairment. There was a significant linear correlation between the risk-AF score and the Rankin score (p < 0.001), the Pfeiffer score (p < 0.001), but not NIHSS score (p 0.150). The overall NNS was 1/19.

Conclusion: Risk stratification allows identifying high-risk individuals in whom to intervene on modifiable risk factors, prioritizing the diagnosis of AF and investigating cognitive status.

Keywords: atrial arrhythmia; cerebrovascular disease; cognitive decline; silent stroke; vascular risk score.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / epidemiology*
  • Brain Ischemia / diagnosis
  • Brain Ischemia / epidemiology*
  • Cognition*
  • Cognitive Dysfunction / diagnosis
  • Cognitive Dysfunction / epidemiology*
  • Cognitive Dysfunction / psychology
  • Female
  • Humans
  • Incidence
  • Male
  • Prevalence
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Sex Factors
  • Spain / epidemiology
  • Stroke / diagnosis
  • Stroke / epidemiology*
  • Time Factors

Grant support

The study received a research grant by Fundació Marató de TV3 in the research call “La Marató 2014: Malalties del Cor”. Grant number: 201528-30-31-3 and received funding from the Spanish Society of Family and Community Medicine -semFYC- by being the winner of a grant for the completion of doctoral theses Isabel Fernández 2020.