Longitudinal Analysis of Predictive Factors for Stroke and Bleeding Events in Atrial Fibrillation Patients: Insights From a Tertiary Care Center Cohort

TL;DR

This study identifies age and prior stroke as key predictors of stroke and bleeding risks in atrial fibrillation patients over 18 months.

Contribution

The study provides new insights into longitudinal risk factors for stroke and bleeding in atrial fibrillation patients using a tertiary care cohort.

Findings

Age over 70 and prior stroke history significantly increase stroke risk in AF patients.

Prior stroke is also a significant predictor of bleeding events.

Stroke and bleeding incidence rates increased over time, highlighting the need for tailored risk management.

Abstract

Background: Atrial fibrillation (AF) represents a prevalent cardiac arrhythmia associated with increased risks of stroke and bleeding events, necessitating comprehensive risk assessment and management strategies.

Objective: This retrospective cohort research aimed to longitudinally analyze risk factors associated with stroke and bleeding incidents in patients diagnosed with AF, focusing on identifying predictive factors and their impact on patient outcomes.

Methods: The research enrolled 480 AF patients from a tertiary care center over an 18-month period (2021-2022). Baseline demographic, clinical, and medication data were collected from electronic health records. Patients were monitored for occurrences of stroke and bleeding events during follow-up. Cox proportional hazards models and Kaplan-Meier estimates were utilized to assess risk factor associations and cumulative event incidences, respectively.

Results: A cohort of 480 AF patients, with a mean age of 65.4 years, was observed over 18 months. Stroke patients tended to be older (72.1 years), and bleeders slightly younger (68.8 years). Cox models revealed higher stroke risk in >70-year-olds (hazard ratio (HR): 1.85, 95% confidence interval (95% CI): 1.21-2.78, p < 0.001) and with prior stroke history (HR: 2.13, 95% CI: 1.45-3.12, p < 0.001). Prior stroke linked to bleeding risk (HR: 1.88, 95% CI: 1.26-2.81, p = 0.003). At six months, stroke incidence was 5.2%, bleeding 3.8%; at 18 months, 12.5% experienced strokes, 9.3% bleeding. These findings underscore age and prior stroke as vital predictors of adverse outcomes in AF patients.

Conclusion: This research reaffirms age and prior stroke as pivotal risk factors for adverse outcomes in AF patients. The findings emphasize the necessity for tailored risk stratification and interventions to mitigate stroke and bleeding risks, thereby enhancing patient care and prognosis in AF management.

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