Abstract
ObjectiveChinese herbal products (CHPs) are widely used for atrial fibrillation (AF) in Taiwan. We investigated the effect of adjuvant CHPs in preventing ischemic stroke in patients with AF.MethodsTaiwanese patients in the Health Insurance Database newly diagnosed with AF during 2000–2011 were enrolled. Medication treatment with/without CHPs was administered within 7 days after the AF diagnosis. The clinical endpoint was an ischemic stroke. The Chi-square test, Fisher’s exact test, and Student t test were used to examine differences between the traditional Chinese medicine (TCM) and non-TCM cohorts. Cox proportional hazard regression was used to assess the risk for ischemic stroke between two cohorts.ResultsThree hundred and eleven patients underwent TCM treatment and 1715 patients did not. Compared to non-TCM users, TCM users had a lower incidence of stroke (12.59% vs. 1.93%, respectively) and lower risk of stroke [CHA2DS2-VASc score = 0–2 (hazard ratio = 0.20; 95% confidence interval = 0.06–0.65)]. Compared to non-TCM users, the stroke risk was significantly lower in TCM users with AF who were female or younger than 65 years, but not in males, people more than 65 years old, or people with comorbidities. Compared to TCM users, non-TCM users who received conventional treatment had a higher ischemic stroke risk. The risk for AF-related hospitalization was significantly lower in TCM users (0.64%) than in non-TCM users (38.1%).ConclusionsUsers of TCM with AF have a lower risk of new-onset ischemic stroke. Therefore, adjuvant CHP therapy may have a protective effect and may be used in AF patients to prevent ischemic stroke.
Highlights
Atrial fibrillation (AF) is characterized by disorganized, rapid, and irregular atrial activation with loss of atrial contraction and an irregular ventricular rate that is determined by AV nodal conduction [1]
Users of traditional Chinese medicine (TCM) with AF have a lower risk of new-onset ischemic stroke
We investigated the effect of adjuvant Chinese herbal products (CHPs) therapy on preventing ischemic strokes in patients with AF
Summary
Atrial fibrillation (AF) is characterized by disorganized, rapid, and irregular atrial activation with loss of atrial contraction and an irregular ventricular rate that is determined by AV nodal conduction [1]. It is the most common arrhythmia and significantly increases stroke risk in adults. The risk of stroke can be estimated by calculating the CHA2D2-VASc score, [7] called the Birmingham 2009 scheme, which is obtained by assigning one point for each of the following factors: congestive heart failure, hypertension, age older than 75 years, diabetes mellitus, female, and vascular disease, while assigning two points for a history of stroke or transient ischemic attack. Patients with AF under anticoagulation therapy might show a sudden onset of hemorrhagic stroke or an adverse effect such as gastrointestinal or urinary tract bleeding [10]
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