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Risks of Death and Stroke in Patients Undergoing Hemodialysis With New-Onset Atrial Fibrillation
- Source :
- Circulation. 133:265-272
- Publication Year :
- 2016
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2016.
-
Abstract
- Background— Whether oral anticoagulant use should be considered in patients undergoing hemodialysis with atrial fibrillation (AF) remains controversial because of the uncertainty regarding risk-benefit assessments. The purpose of this study was to investigate the risk of ischemic stroke in patients undergoing hemodialysis with new-onset AF, in comparison with those without arrhythmia. Methods and Results— This nationwide, population-based, propensity score–matched cohort study used data from Taiwan’s National Health Insurance Research Database during 1998 to 2011 for patients on hemodialysis with new-onset nonvalvular AF and matched subjects without arrhythmia. The clinical end points were ischemic stroke (fatal or nonfatal), all-cause death, and other serious adverse cardiovascular events. In comparison with the matched cohort, patients with AF (n=6772) had higher risks of ischemic stroke (adjusted hazard ratio [aHR], 1.27; 95% confidence interval [CI], 1.13–1.43), all-cause death (aHR, 1.59; 95% CI, 1.52–1.67), in-hospital cardiovascular death (aHR, 1.83; 95% CI, 1.71–1.94), myocardial infarction (aHR, 1.33; 95% CI, 1.17–1.51), and hospitalization for heart failure (aHR, 1.90; 95% CI, 1.76–2.05). After considering in-hospital death as a competing risk, AF significantly increased the risk of heart failure (HR, 1.56; 95% CI, 1.45–1.68), but not those of ischemic stroke and myocardial infarction. Additionally, the predictive value of the CHA 2 DS 2 –VASc score for ischemic stroke was diminished in the competing-risk model. Conclusions— The risk of stroke was only modestly higher in patients undergoing hemodialysis with new-onset AF than in those without AF, and it became insignificant when accounting for the competing risk of in-hospital death.
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
Statistics as Topic
Taiwan
030232 urology & nephrology
030204 cardiovascular system & hematology
Competing risks
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Renal Dialysis
Risk Factors
Physiology (medical)
Atrial Fibrillation
medicine
Humans
In patient
Hospital Mortality
Intensive care medicine
Stroke
Aged
Retrospective Studies
Aged, 80 and over
business.industry
Atrial fibrillation
Middle Aged
medicine.disease
New onset atrial fibrillation
Population Surveillance
Cohort
Oral anticoagulant
Female
Hemodialysis
Cardiology and Cardiovascular Medicine
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 15244539 and 00097322
- Volume :
- 133
- Database :
- OpenAIRE
- Journal :
- Circulation
- Accession number :
- edsair.doi.dedup.....0d56090d1c913cc212283d877390bfd8