Abstract
Background: Hyperthyroidism is associated with atrial fibrillation (AF), and the latter is a major risk factor for stroke. Aim: We aimed to investigate the yearly incidence of stroke and bleeding in AF patients with and without concomitant hyperthyroidism from the French National Hospital Discharge Database. Methods: Admissions with AF between January 2010 and December 2019 were retrospectively identified and retrieved from the French national database. Incidence rates of ischaemic stroke and bleeding were compared in AF patients with and without concomitant hyperthyroidism. The associations of risk factors with ischaemic stroke were assessed by Cox regression. Results: Overall 2,421,087 AF patients, among whom 32,400 had concomitant hyperthyroidism were included in the study. During the follow-up (mean: 2.0 years, standard deviation SD: 2.2 years), the yearly incidence of ischaemic stroke was noted to be 2.6 (95% confidence interval CI: 2.5–2.8) in AF patients with concomitant hyperthyroidism, and 2.3 (95%CI: 2.3–2.4) in non-thyroid AF patients. Hyperthyroidism was noted as an independent risk factor for ischaemic stroke (adjusted hazard ratio aHR: 1.133, 95%CI: 1.080–1.189) overall, particularly within the first year of hyperthyroidism diagnosis (aHR 1.203, 95%CI 1.120–1.291), however, the association became non-significant in subsequent years (aHR 1.047, 95%CI 0.980–1.118). Major bleeding incidence was lower in the hyperthyroid AF group in comparison to the non-thyroid AF group (incidence ratio: 5.1 vs. 5.4%/year, p < 0.001). The predictive value of CHA2DS2VASc and HAS-BLED scores for ischaemic stroke and bleeding events, respectively, did not differ significantly between AF patients with or without concomitant hyperthyroidism. Conclusions: Hyperthyroidism seems to be an independent risk factor of ischaemic stroke in AF patients, particularly within the first year of hyperthyroidism diagnosis.
Highlights
Hyperthyroidism, a common endocrine disorder, affects 0.5% to 2% of the general population [1]
On multivariable Cox regression analysis, the presence of hyperthyroidism (HR 1.133, 95% Confidence Interval (95%CI) 1.080–1.189, p < 0.0001) was independently of hyperthyroidism (HR 1.133, 95%CI 1.080–1.189, p < 0.0001) was independently associated associated with ischaemic stroke in the overall cohort (Table 2) This risk was with ischaemic stroke in the overall cohort (Table 2) This risk was evident evident within the first year of hyperthyroidism diagnosis (HR 1.203, 95%CI 1.120–1.291), within the first year of hyperthyroidism diagnosis (HR 1.203, 95%CI 1.120–1.291), with a with a nonsignificant association beyond year
The generalization of our findings to other populations and regions might be limited given different ethnic compositions, level of healthcare service and prevalence of the relevant diseases and risk factors. In this nationwide atrial fibrillation study, the highest incidence of ischaemic stroke was noted in hospitalised AF patients within the first year of hyperthyroidism diagnosis, during which period hyperthyroidism seemed to be an independent risk factor of ischaemic stroke
Summary
Hyperthyroidism, a common endocrine disorder, affects 0.5% to 2% of the general population [1]. Atrial fibrillation (AF) is the most common cardiac condition associated with hyperthyroidism; its prevalence was estimated to be 10% to 25% in overtly hyperthyroid patients as compared to 1.5–2% in the general population [2]. The association was insignificant in those ≥65 years of age or those with high cardiovascular risk Hyperthyroidism is associated with atrial fibrillation (AF), and the latter is a major risk factor for stroke. Aim: We aimed to investigate the yearly incidence of stroke and bleeding in AF patients with and without concomitant hyperthyroidism from the French National. 2019 were retrospectively identified and retrieved from the French national database. Incidence rates of ischaemic stroke and bleeding were compared in AF patients with and without concomitant hyperthyroidism. The associations of risk factors with ischaemic stroke were assessed by Cox regression
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