Abstract
BackgroundAge is a well‐established risk factor for thromboembolic events in patients with atrial fibrillation (AF). However, the mechanism underlying the association between age and thromboembolic events in AF remains unknown.MethodsThe prognostic value of age as a risk factor for thromboembolic events was analyzed using data from the Korean National Health Insurance Service (NHIS). In a large‐scale single‐center registry, cardiac hemodynamic parameters were examined to elucidate the cause of increased risk of thromboembolic events in older patients.ResultsNHIS sample cohort data including 5896 patients with AF revealed that the risk of thromboembolic complication differed significantly according to age despite equal CHA2DS2‐VASc score. In the registry of 2801 patients, age showed significant correlations with left atrium (LA) diameter, LA volume, E/e′, pulmonary artery pressure, and LA appendage flow velocity. Older patients had a significantly higher prevalence of spontaneous echocontrast (odds ratio [OR] = 1.030; P < .001). Age (OR = 1.031; P < .001), E/e′ (OR = 1.065; P = .004), and LA appendage flow velocity (OR = .988; P = .009) were significant predictors for thromboembolic events in multivariate analyses. In data from the NHIS, CHA2DS2‐VASc score did not outperform age to predict thromboembolic events.ConclusionsAge is a significant risk factor for thromboembolic events in patients with AF, and old age is associated with adverse cardiac hemodynamics. This study suggests that older patients with AF are at high risk of thromboembolic events regardless of CHA2DS2‐VASc score.
Highlights
A substantial proportion of ischemic stroke, transient ischemic attack (TIA), and systemic embolism are caused by atrial fibrillation (AF).[1-3]
The use of anticoagulation therapy to prevent thromboembolic events in patients with AF is guided by the CHA2DS2-VASc scoring system, and anticoagulation should be recommended to patients with CHA2DS2-VASc score ≥ 2.10,11 The CHA2DS2-VASc system can identify patients at low risk for thromboembolic events.[13]
The major findings of our study are summarized as follows: (a) risk of thromboembolic events in patients with AF differs significantly according to age; (b) increased CHA2DS2-VASc score due to age criteria is associated with higher risk of thromboembolic events; (c) intermediate age group (50-65) has an increased risk of thromboembolic events they do not receive age points in the CHA2DS2-VASc scoring system; (d) old age is associated with adverse cardiac hemodynamics; (e) old age, increased E over e0 (E/e0), and decreased LA appendage (LAA) flow velocity are independent risk factors for thromboembolic events in patients with AF
Summary
A substantial proportion of ischemic stroke, transient ischemic attack (TIA), and systemic embolism are caused by atrial fibrillation (AF).[1-3]. CHA2DS2-VASc score is calculated by summing seven components: congestive heart failure, hypertension, age, diabetes, previous stroke/TIA/systemic embolism, vascular disease, and sex category.[7,12]. The mechanism underlying age as a dominant risk factor for thromboembolic events in patients with AF is not fully understood. We aimed to evaluate the relative importance of age as a risk factor for thromboembolic events and to elucidate the underlying pathophysiology of the association between age and thromboembolic events. We used both the Korean National Health Insurance Service (K-NHIS) sample cohort data and the Korea University Medical Center Anam Hospital radiofrequency catheter ablation (RFCA) registry (KUMC registry)
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