Atrial Fibrillation In China Research Articles

Sex Differences in Presentation, Quality of Life, and Treatment in Chinese Atrial Fibrillation Patients: Insights from the China Atrial Fibrillation Registry Study.

BackgroundThere is a growing recognition of sex-related disparities in atrial fibrillation (AF). However, limited data is available in Chinese AF patients.Material/MethodsWe compared symptoms, quality of life (QoL), and treatment of AF according to sex from the China AF Registry study.ResultsWe studied 14 723 patients with non-valvular AF, of whom 5645 patients (38.3%) were female. Women were older than men (67.5±10.6 vs. 62.2±12.2). Compared to men, women had more comorbidities and a higher proportion of CHA2DS2-VASC score ≥2. Women with AF experienced more severe or disabling symptoms than men (33.7% vs. 22.9% in age <75 group; 40.3% vs. 28.7% in age ≥75 group; both P<0.0001). After multivariate analysis, women with AF still had lower QoL (OR 0.69; 95%CI, 0.63–0.76; P<0.0001). Women tended to have lower rates of ablation and rhythm-control drug use in those aged <75 years. Oral anticoagulant use was low and had no sex difference in AF patients with a CHA2DS2-VASC score ≥2.ConclusionsIn Chinese AF patients, women were older and more symptomatic, and had worse QoL. Despite all these differences, women tended to receive less rhythm-control treatment in those aged <75 years. Oral anticoagulant was substantially underused in high stroke risk patients, regardless of sex.

Prevalence of modifiable risk factors and relation to stroke and death in patients with atrial fibrillation: A report from the China atrial fibrillation registry study.

Lifestyle and risk factor management may improve outcomes in patients with atrial fibrillation (AF). We aim to evaluate the prevalence of modifiable risk factors and how these factors impact clinical outcomes in patients with AF. Data on 17 898 AF cohort patients with AF enrolled between 2011 and 2016 was analyzed. A healthy lifestyle was defined as not smoking, not drinking, a healthy body mass index (BMI), untreated total cholesterol less than 200 mg/dL, untreated blood pressure (BP) less than 120/80 mm Hg, and untreated fasting plasma glucose (FPG) less than 100 mg/dL. The association between risk factors and risk of the composite endpoint of all-cause mortality and nonfatal ischemic stroke were assessed using Cox proportional hazards regression model. Only 4.0% of patients achieved a healthy lifestyle. In multivariate analysis, current smoking, a low BMI, not well-controlled FPG were independently and significantly associated with higher risk of all-cause mortality and nonfatal ischemic stroke, with corresponding hazard ratio (HR) estimates 1.22 (95% confidence interval [CI], 1.00-1.47), HR = 1.72 (95% CI, 1.34-2.20), and HR = 1.25 (95% CI, 1.06-1.46), respectively. High BP was also associated with higher risk with the outcomes (HR = 1.15, 95% CI, 1.00-1.34). Compared with patients with no risk factor, those who failed to maintained or achieved optimal risk factor control had a progressively higher risk of death and nonfatal ischemic stroke (HR for 1 risk factor = 1.44; 95% CI, 1.07-1.92; and more than 2 risk factors = 1.75; 95% CI, 0.99-3.09). Maintenance of well-controlled risk factors may substantially lower the risk of death and ischemic stroke in patients with AF.

Newly detected atrial fibrillation is associated with cortex-involved ischemic stroke

Background:Both cortical and cortical-subcortical (cortex-involved) lesions are typically associated with embolic stroke, of which atrial fibrillation (AF) is the common cause. The aim of this study was to find out the associations between cortex-involved stroke, vascular risk factors, and the subtypes (discovery time and duration) of AF.Methods:This was an imaging study of the China Atrial Fibrillation Screening in Acute Ischemic Stroke Patients (CRIST) trial. Between October 2013 and June 2015, 1511 acute ischemic stroke or transient ischemic attack (TIA) patients within 7 days after stroke onset at 20 Chinese hospitals were enrolled in this prospective, multicenter cohort, cross-sectional study. The final analysis of this sub-study included 243 patients with AF with required magnetic resonance imaging (MRI) sequences. AF was diagnosed by 6-day Holter monitoring and classified by duration of 24 h. Two stroke specialists blinded to the clinical information reviewed MRI (diffusion-weighted MRI). The third stroke specialists, also blinded to the clinical information, assessed the conflicts. Adjusted large artery atherosclerosis as confounding factor, the associations between cortex-involved lesions, vascular risk factors, and the subtype of AF were evaluated by univariate and multivariate regression analyses.Results:Of 243 acute ischemic stroke patients with AF, 190 were known AF and 53 were newly detected AF. There were 28 patients with AF persistent >24 h and 25 persistent ≤24 h in newly detected AF. Patients with newly detected AF were likely to have a fewer history of stroke or TIA (16.98% vs. 36.31%, P = 0.008) and lower fasting blood glucose (5.91 ± 1.83 mmol/L vs. 6.75 ± 3.83 mmol/L, P = 0.030) than patients with known AF. Among these 243 patients, 102 (41.98%) patients were with cortex-involved lesions. Cortex-involved lesions were significantly related to newly detected AF persistent >24 h (odds ratio [OR]: 4.517, 95% confidence interval [CI]: 1.490–13.696, P = 0.008), proteinuria (OR: 3.431, 95% CI: 1.530–7.692, P = 0.021), and glycosylated hemoglobin (OR: 0.632, 95% CI: 0.464–0.861, P = 0.004).Conclusions:Compared to previously known AF, newly detected AF persistent >24 h was associated with cortex-involved ischemic stroke.Clinical trial registration:NCT02156765, https://clinicaltrials.gov/ct2/show/record/NCT02156765

The Association Between the Use of Antiarrhythmic Drugs in Non-Valvular Atrial Fibrillation and Patient Prognosis Using Data from the China Atrial Fibrillation (China-AF) Registry.

BackgroundResults of the landmark Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) trial comparing rhythm control and rate control strategies has led to dramatic changes in the pharmacological management of non-valvular atrial fibrillation (NVAF) patients. We sought to investigate the effect of antiarrhythmic drugs (AADs) on the clinical outcomes of NVAF patients using “real-world” data from China.Material/MethodsWe evaluated the association between AAD usage and clinical outcomes using clinical data of 8161 NVAF patients who were AAD-naive before enrollment in the China Atrial Fibrillation Registry, recruited between August 2011 and February 2017. The primary outcome was all-cause mortality.ResultsCompared with 6167 patients who never used any AADs, 1994 patients in the AAD group had lower incidence (per 100 person-years) of all-cause mortality (1.44 versus 3.91), cardiovascular death (0.45 versus 2.31), ischemic stroke (1.36 versus 2.03), and cardiovascular hospitalization (9.83 versus 10.22) over a mean follow-up duration of 316.7±90.4 days. After adjusting for potential confounders, AAD usage was associated with a lower risk of all-cause mortality [hazard ratio (HR): 0.50, 95% confidence interval (CI): 0.31–0.81] and decreased risk of cardiovascular death (HR: 0.30, 95% CI: 0.13–0.68). Subgroup analysis revealed AAD was associated with higher risk of cardiovascular hospitalization among female patients.ConclusionsAAD usage was associated with lower risk of 1-year all-cause mortality and cardiovascular death in “real-world” patients with NVAF.

Cost-Effectiveness of Cryoballoon Ablation Versus Radiofrequency Ablation for Paroxysmal Atrial Fibrillation in China: Results Based on Real-World Data

BackgroundParoxysmal atrial fibrillation (AF) presents a significant economic burden to the healthcare system. Catheter ablations is a commonly adopted treatment for paroxysmal AF. ObjectivesTo evaluate the cost effectiveness of cryoballoon ablation versus radiofrequency ablation in patients with drug-refractory paroxysmal AF in a tertiary hospital in China. MethodsA Markov model was developed to study the effects and costs. Cost and probability input data were obtained mainly from a retrospective real-world study conducted in a tertiary hospital. Propensity score matching was used to overcome retrospective bias. Input data gaps were remedied by means of literature review and advice from experts. A simulation was performed for the post-procedure lifetime years. Univariate and probabilistic sensitivity analyses were conducted. ResultsIn the base-case analysis of a lifetime time horizon, a patient treated with cryoballoon ablation was associated with 7.85 quality-adjusted life-years (QALYs) and ¥132 222 ($19 913) total costs, whereas a radiofrequency ablation treated patient was associated with 7.71 QALYs and ¥147 304 ($22 184) total costs. The cryoballoon group had slightly better health outcomes (with a difference of 0.14 QALY) and lower total costs (with a difference of ¥15 082) (USD $2 271), and it may be considered as cost-effective or cost-saving strategy (incremental cost-effectiveness ratio -¥110 158 [$16 590] per QALY) for the management of paroxysmal AF. Different scenarios were tested with sensitivity analyses, but still, the outcomes remained cost-effective or cost-saving for cryoballoon ablation. ConclusionsAn economic evaluation based on real-world data suggests that, relative to radiofrequency ablation, cryoballoon ablation may be considered as a more cost-effective or cost-saving long-term strategy for drug-refractory paroxysmal AF in this tertiary hospital in China. However, further evidence is needed using data from large-scale studies in order to reflect a national perspective.

Abstract TP354: Usage of New Oral Anticoagulants Among Acute Ischemic Stroke Patients with Atrial Fibrillation in China: Findings from Chinese Stroke Center Alliance

Background and Purpose: Previous studies have reported the underuse of warfarin for ischemic stroke patients with atrial fibrillation (AF) in China. New oral anticoagulants (NOACs) have become an efficacious alternative to warfarin and been recommended by guidelines. We sought to explore the usage of NOAs and affecting factors in China. Methods: From June 2015 to November 2017, 511 036 patients with acute stroke/TIA were admitted to 1 624 hospitals voluntarily participating in the China Stroke Center Alliance (CSCA), an ongoing, national, hospital-based, multicenter, stroke care quality registry and improvement program. Multivariable logistic regression models using the generalized estimating equation method were used to identify patient/hospital factors independently associated with NOACs use during hospitalization. Results: Among 28 456 ischemic stroke patients with AF, only 798 (2.8%) received NOACs, 8 635 (30.3%) received traditional anticoagulants therapy, 18821 (66.1%) received antiplatelet drugs only. Among patients receiving traditional anticoagulants or NOACs, younger age, lower education level, lower income, rural basic medical insurance schemes, more severity, secondary hospital, Central or West China were associated with lower odds of receiving NOACs (Table 1). Conclusions: Ischemic stroke patients with AF are under treated with anticoagulant, especially with the usage of NOACs. Further efforts are needed to increase the prescription of NOACs and other anticoagulants.

A2528 The Disease Burden of Atrial Fibrillation in China

Objectives: Atrial fibrillation (AF) is the most common type of arrhythmia which is a significant public health issue. We aimed to determine the disease burden of AF in China. Methods: A stratified multistage random sampling method was used to obtain nation-wide sample collections representing the general population over 18 years across China for a hypertension prevalence survey. For the AF prevalence study, selected 262 urban and rural areas were stratified into eastern, middle and western regions according to both geographical location as well as economic level, 34,994 people aged 35 years or older were enrolled from different regions. The AF patients were detected by electrocardiogram (ECG) during the survey or medical history taking. The quality of life in AF patients was assessed by a questionnaire similar to EQ-5D to estimate the weight of disability. Disability Adjusted Life Years (DALY) was then calculated by adding Years of Life Lost (YLL) to Years Lived with Disability (YLD). Results: Overall, 31,230 samples were included in the final analysis, the weighted prevalence of AF in the Chinese population aged 35 years or older was 0.71%, was higher in rural than in urban (0.75% vs. 0.63%), and was highest in eastern area (Figure.1). 34% of AF patients were newly diagnosed in the survey and unaware of their pathological condition beforehand. The AF prevalence gradually, but significantly, increased with age, ranging from 0.10% in the 35–45 age group up to 2.35% in participants aged over 75 years old (P < 0.001). The health-related quality of life was impaired in Chinese AF patients with an overall utility value of 0.53. The total DALY of Chinese AF patient is estimated to be 665,399.78. Conclusion: This nation-wide study indicated that the disease burden of AF in the general Chinese population was a significant

Female Sex as a Risk Factor for Ischemic Stroke and Systemic Embolism in Chinese Patients With Atrial Fibrillation: A Report From the China-AF Study.

BackgroundPrevious studies have provided conflicting results as to whether women are at higher risk than men for thromboembolism in the setting of atrial fibrillation (AF). We investigated whether women with AF were at higher risk of ischemic stroke in the China‐AF (China Atrial Fibrillation Registry) Study.Methods and ResultsA total of 19 515 patients were prospectively enrolled between August 2011 and December 2016 in the China‐AF Study. After exclusion of patients receiving anticoagulation or ablation therapy, 6239 patients (2574 women) with results from at least 6 months of follow‐up were used for the analysis. Cox proportional hazards models were performed to evaluate whether female sex was an independent risk factor for thromboembolism after multivariate adjustment. The primary outcome was the time to the first occurrence of ischemic stroke or systemic embolism. After a mean follow‐up of 2.81±1.46 years, 152 female patients reached the primary outcome, as compared with 172 male patients. Crude incidence rates of thromboembolism between women and men were of borderline statistical significance (2.08 versus 1.68 per 100 patient‐years, P=0.058). After multivariable analysis, female sex was not independently associated with an increased thromboembolism risk (hazard ratio 1.09, 95% confidence interval 0.86‐1.39). There was no significant difference in thromboembolism risk by sex stratified by age and presence or absence of risk factors (P for interaction all >0.1).ConclusionsAlthough crude incidence rates of thromboembolism were higher in Chinese female patients with AF compared with male patients, female sex did not emerge as an independent risk factor for thromboembolism on multivariate analysis.Clinical Trial Registration URL: http://www.chictr.org.cn/. Unique identifier: ChiCTR‐OCH‐13003729.

Underuse of Oral Anticoagulants in Patients With Ischemic Stroke and Atrial Fibrillation in China

Anticoagulant therapy is an effective stroke prevention measurement for subjects with atrial fibrillation (AF) who are at high risk of ischemic stroke. However, it is reported that oral anticoagulants (OACs) are generally underused in clinical practice. A better awareness of current usage of anticoagulant therapy would enable prevention of stroke secondary to AF. Therefore, we determined the nationwide prevalence of AF and the frequency of OACs use among patients with ischemic stroke in China. Based on the China National Stroke Screening Survey, a representative nationwide sample of 1,252,703 adults over 40 years old during 2013 and 2014 was involved. Information on demographic data, diagnosis of stroke, behavioral risk factors, family history of stroke, related diseases, and medications was collected. The community-based survey data showed that 5,588 patients (12.0%) with ischemic stroke had previous, or newly diagnosed, AF. Therefore, more than 2.15 million ischemic stroke patients had AF in China. Among ischemic stroke patients with AF, the strongest risk factor was coronary heart disease (odds ratio = 2.53), whereas dyslipidemia accounted for the largest contribution (population-attributable risk proportion = 17.33%). Of ischemic stroke patients with AF, only 2.2% had taken OACs; of them, 98.2% had taken warfarin. In conclusion, a large number of ischemic stroke patients with AF are significantly undertreated with OACs in China. This highlights the need for improvement of prevention of ischemic stroke secondary to AF.

The Disease Burden of Atrial Fibrillation in China from a National Cross-sectional Survey

Atrial fibrillation (AF) is the most common type of arrhythmia, which is a significant public health issue. We aimed to determine the disease burden of AF in China. We used a recent national survey with stratified multistage random sampling from general Chinese population to estimate the AF disease burden, which enrolled 34,994 people aged 35 years or older all over China. The AF patients were detected by electrocardiogram during the survey or medical history taking. The quality of life in AF patients was assessed by a questionnaire similar to EQ-5D to estimate the weight of disability. Disability-adjusted life years was then calculated by adding years of life lost to years lived with disability. Overall, 31,230 samples were included in the final analysis, the weighted prevalence of AF in the Chinese population aged 35 years or older was 0.71%. Thirty-four percent of AF patients were newly diagnosed in the survey and unaware of their pathological condition beforehand. The prevalence of AF significantly increased with age. The health-related quality of life was impaired in Chinese AF patients with an overall utility value of 0.53. The total disability-adjusted life years of Chinese AF patient is estimated to be 665,400. In conclusion, the disease burden of AF in the general Chinese population was a significant public health issue in China.

PCV60 - Cost-Effectiveness Of Rivaroxaban Compared With Real-World Treatment For Stroke Prevention In Non-Valvular Atrial Fibrillation In China

To evaluate the cost-effectiveness of rivaroxaban over real-world treatment prescribing scenario (i.e. 23% of patients receiving warfarin, 57% of patients receiving aspirin, or 20% of patients receiving no treatment in a cohort of warfarin-eligible patients) for stroke prevention in non-valvular atrial fibrillation (NVAF) patients in China. A Markov model was designed from a payer’s perspective to evaluate the costs and quality-adjusted life years (QALYs) of NVAF patients treated with rivaroxaban or real-world prescribing. Clinical data were from ROCKET AF trial or network meta-analysis to estimate the transition probabilities. Data on Chinese health resource use, unit costs and utility parameters were collected from previously published literature. The time horizon was set at patients’ lifetime and a 3-month cycle length was used in the model. All costs were expressed as the 2017 USD (exchange rate, 1 USD = 6.67 Chinese Yuan) with future costs discounted at 5% per year. One-way sensitivity analyses and probability sensitivity analyses were undertaken to further assess the uncertainty of the cost-effectiveness results of rivaroxaban over real-world treatment. Rivaroxaban therapy resulted in the gain of 6.90 QALYs, with the total lifetime costs USD 17,269. And the real-world prescribing mixture resulted in 6.43 QALYs, with the costs USD 8,157. The ICER of rivaroxaban was USD 19,563 per QALY versus the real-world treatment. Sensitivity analysis indicated that the result was most sensitive to relative risk (RR) of stroke for rivaroxaban and rivaroxaban would be cost-effective, assuming a willingness-to-pay threshold of USD 24,279 per QALY. It demonstrates that rivaroxaban therapy is a cost-effective alternative to real-world treatment for stroke prevention of NVAF patients in China.

Late outcome of surgical radiofrequency ablation for persistent valvular atrial fibrillation in China: a single-center study

BackgroundAtrial fibrillation (AF) adversely affects surgical outcomes of cardiac valve surgery. Surgical ablation is an effective way to treat valvular AF. The aim of this study was to evaluate the late outcome of surgical radiofrequency ablation and explore the risk factors of AF recurrence in Chinese patients undergoing cardiac valve surgery.MethodsThree hundred ninety six consecutive patients with persistent valvular AF were enrolled in this study. They underwent concomitant modified Maze IV and were completed follow-ups. Cox survival regression model was used to screen independent risk factors for predicting late recurrence of AF.ResultsDuring the follow-up period of 28 (6 ~ 61) months, AF recurred in 151 patients (38.1%). In multivariate survival regression, factors predictive of AF late recurrence were AF duration, pre-operative serum B-type natriuretic peptide (BNP), pre-operative heart rate and left atrial diameter (LAD), post-operative atrial tachyarrhythmias and AF at discharge. According to receiver operating characteristic curve analysis, the best cutoff values for AF duration, BNP, heart rate and LAD were 66.5 months, 251 pg/ml, 82 beats/min and 67.9 mm, respectively.ConclusionsLonger AF duration, larger LAD, higher BNP level and lower heart rate indicated a poor late outcome of surgical radiofrequency ablation in persistent AF patients undergoing cardiac valve surgery. Therefore, indication to radiofrequency ablation should be carefully considered in these patients.

Sex Differences in Outcomes among Stroke Survivors with Non-Valvular Atrial Fibrillation in China.

Atrial fibrillation (AF) significantly increases the risk of stroke and disease burden and is an established predictor of poor outcomes after stroke. However, data regarding sex differences in long-term outcomes following stroke in patients with AF are scarce. We thus aimed to assess these differences. We recruited 951 consecutive patients with acute ischemic stroke and non-valvular atrial fibrillation (NVAF) treated at three hospitals in Tianjin, China, from January 2006 to September 2014. Information regarding stroke subtype, severity, risk factors, and outcomes (mortality, dependency, and recurrence) at 3, 12, and 36 months after stroke was recorded. The prevalence of NVAF was 8.4% overall, with a higher frequency in women than in men (11.3 vs. 6.9%, P < 0.001). Among patients with NVAF, women were older than men. Women were more likely than men to have severe stroke (38.8 vs. 29.5%, P < 0.001), high levels of total cholesterol and high- and low-density lipoprotein cholesterol (all P < 0.001), hypertension (69.1 vs. 61.2%, P = 0.012), dyslipidemia (29.8 vs. 20.7%, P = 0.001), and obesity (18.5 vs. 11.6%, P = 0.003); they were less likely than men to be current smokers (12.2 vs. 33.6%, P < 0.001) and to consume alcohol (0.9 vs. 13.9%, P < 0.001). There were greater risks of dependency and recurrence at 36 months after stroke in women than in men [odds ratios (95% confidence intervals), 1.64 (1.02–2.64) for dependency, P = 0.043; and 2.03 (1.28–3.20) for recurrence, P = 0.002] after adjustment for stroke subtype, severity, and risk factors. These findings suggest that it is crucial to emphasize the need for individualized stroke prevention education and promotion of healthy lifestyles in order to improve NVAF-related stroke outcomes and reduce disease burden in women.

Effect of age on long-term outcomes after stroke with atrial fibrillation: a hospital-based follow-up study in China.

Atrial fibrillation (AF) is an established predictor of poor outcomes after stroke. We aimed to assess the effect of age on outcomes at 1 year and 3 years in stroke patients with AF. We recruited acute ischemic stroke patients with AF between January 2006 and September 2014 in Tianjin, China. Clinical features and outcomes at 1 year and 3 years after stroke were compared between younger group and elderly group. Overall, 951 consecutive stroke patients with AF were included in this study. There was a higher mortality and dependency rate in the elderly group than in the young group at both 1 and 3 years after stroke. Recurrence rates were significantly higher in the elderly group than in the young group at 3 years after stroke. The higher risks of mortality and dependency in elderly patients remained unchanged, but disappeared in recurrence rates after adjusting for stroke subtype, severity, risk factors, and lifestyle. These findings suggest that it is crucial to highlight the treatment of elderly stroke patients with AF in order to reduce poor outcomes and to reduce the burden of AF in China.

Factors influencing medication knowledge and beliefs on warfarin adherence among patients with atrial fibrillation in China.

ObjectivesWarfarin is often used for ischemic stroke prevention in patients with atrial fibrillation (AF), but the factors affecting patient adherence to warfarin therapy have not been fully understood.MethodsA cross-sectional survey was conducted in AF patients undergoing warfarin therapy at least 6 months prior to the study. The clinical data collected using questionnaires by phone interviews included the following: 1) self-reported adherence measured by the Morisky Medication Adherence Scale-8©; 2) beliefs about medicines surveyed by Beliefs about Medicines Questionnaire (BMQ); and 3) drug knowledge as measured by the Warfarin Related Knowledge Test (WRKT). Demographic and clinical factors associated with warfarin adherence were identified using a logistic regression model.ResultsTwo hundred eighty-eight patients completed the survey and 93 (32.3%) of them were classified as nonadherent (Morisky Medication Adherence Scale-8 score <6). Major factors predicting warfarin adherence included age, cardiovascular disorders, WRKT, and BMQ; WRKT and BMQ were independently correlated with adherence to warfarin therapy by multivariate logistic regression analysis. Adherents were more likely to have greater knowledge scores and stronger beliefs in the necessity of their specific medications ([odds ratio {OR} =1.81, 95% confidence interval {CI} =1.51–2.15] and [OR =1.17, 95% CI =1.06–1.29], respectively). Patients with greater concerns about adverse reactions and more negative views of general harm were more likely to be nonadherent ([OR =0.76, 95% CI =0.69–0.84] and [OR =0.82, 95% CI =0.73–0.92], respectively).ConclusionBMK and WRKT are related with patient behavior toward warfarin adherence. BMQ can be applied to identify patients at increased risk of nonadherence.

Long-Term Outcomes after Stroke in Elderly Patients with Atrial Fibrillation: A Hospital-Based Follow-Up Study in China.

Background: Atrial fibrillation (AF) significantly increases the risk of stroke and disease burden; it is an established predictor of poor outcomes after stroke. However, reported differences in outcomes after stroke among elderly patients between AF and non-AF group are conflicting. We aimed to compare differences in outcomes at 1 year and 3 years after stroke among elderly patients (aged ≥ 75 years old) between AF group and non-AF group.Methods: We recruited 1070 consecutive elderly patients who experienced acute ischemic stroke between January 2008 and December 2013 in Jiamusi University First Hospital, China in this study. Information regarding stroke subtype, severity, risk factors, and outcome (mortality, dependency, and recurrence) at 3 and 12 months after stroke were recorded and assessed between AF group and non-AF group.Results: The prevalence of AF was 16.1% overall, with a similar trend in the prevalence of AF between men and women. The AF group were more likely to experience severe stroke compared to the non-AF group (32.0 vs. 11.9%, respectively; P < 0.001). There were no obvious differences between groups regarding the prevalence of hypertension, dyslipidemia, obesity, current smoking, and alcohol drinking but there was a higher prevalence of diabetes in the non-AF group (20.3 vs. 30.1%, P = 0.010). Mortality and dependency rates were significantly higher in the AF group than in the non-AF group at 1 year after stroke (29.6 vs. 17.8%, P = 0.001 for mortality; and 59.5 vs. 36.1%, P = 0.010 for dependency) and 3 years after stroke (46.1 vs. 33.2%, P = 0.032 for mortality; and 70.7 vs. 49.2%, P = 0.010 for dependency); however, there was no significant between-groups differences in rates of recurrence across the follow-up periods. The results for dependency remained stable after adjustment for sex, stroke severity, and stroke risk factors at 3 years after stroke (OR, 2.26; 95% CI, 1.06–4.81; P = 0.034); however, the relationship between AF and mortality and recurrence disappeared after adjusting for these covariatesConclusion: These findings suggest that it is crucial to highlight the treatment of elderly stroke patients with AF in order to reduce poor outcomes among the elderly and to reduce the burden of AF in China.

Use of Warfarin at Discharge Among Acute Ischemic Stroke Patients With Nonvalvular Atrial Fibrillation in China.

Guidelines recommend oral anticoagulation for ischemic stroke patients with atrial fibrillation, and previous studies have shown the underuse of anticoagulation for these patients in China. We sought to explore the underlying reasons and factors that currently affect the use of warfarin in China. From June 2012 to January 2013, 19 604 patients with acute ischemic stroke were admitted to 219 urban hospitals voluntarily participating in the China National Stroke Registry II. Multivariable logistic regression models using the generalized estimating equation method were used to identify patient/hospital factors independently associated with warfarin use at discharge. Among the 952 acute ischemic stroke patients with nonvalvular atrial fibrillation, 19.4% were discharged on warfarin. The risk of bleeding (52.8%) and patient refusal (31.9%) were the main reasons for not prescribing anticoagulation. Larger/teaching hospitals were more likely to prescribe warfarin. Older patients, heavy drinkers, patients with higher National Institutes of Health Stroke Scale score on admission were less likely to be given warfarin, whereas patients with history of heart failure and an international normalized ratio between 2.0 and 3.0 during hospitalization were significantly associated with warfarin use at discharge. The rate of warfarin use remains low among patients with ischemic stroke and known nonvalvular atrial fibrillation in China. Hospital size and academic status together with patient age, heart failure, heavy alcohol drinking, international normalized ratio in hospital, and stroke severity on admission were each independently associated with the use of warfarin at discharge. There is much room for improvement for secondary stroke prevention in nonvalvular atrial fibrillation patients in China.

Study on the quality and prognosis of long-term oral anticoagulation therapy in elderly patients with non-valvular atrial fibrillation

Objective To investigate the status of oral anticoagulation therapy (OAC) in elderly patients with non-valvular atrial fibrillation, and evaluate its quality and the curative efficacy. Methods The research was a single center registration study in a tertiary referral hospital in Beijing. We registered 564 consecutive patients with non-valvular atrial fibrillation including 348 elderly patients (61.7%) who were over 65-years old from Aug 2012 to Dec 2013. The anticoagulation status of patients, clinical events and quality of anticoagulation treatment were documented by a long-term follow-up of all patients. Quality of anticoagulation was expressed as time in therapeutic range (TTR) calculated by the linear interpolation method. Results A total of 309 patients consisted of the cohort of study after excluding patients undergoing catheter ablation. The mean follow-up time was (13.4±4.8) months. 92 patients (30.2%) were in long-term adherence to oral anticoagulant therapy including 55 cases (35.3%) in group aged 65-74 years and 37 cases (25.0%) in group aged 75-92 years. A total of 599 INR values from 67 patients (72.8%) were acquired for analysis. The mean INR was 2.1. The overall mean TTR was 56.2%. There was no significant difference in the analysis of TTR between the two groups at different ages. All-cause mortality was higher in group aged 75-92 years than in group aged 65-74 years 〔8.8% (13 cases) vs. 2.6% (4 cases), P<0.05〕. But no difference in mortality associating thrombotic and hemorrhagic events caused by atrial fibrillation and OAC was observed between the two age groups. The annual stroke incidence was 3.1% (11 cases) in total population, and there was no difference in the annual stroke incidence between the two age groups. The rate of hemorrhage which mainly was minor bleeding, was higher in warfarin group than in the non-warfarin group 〔31.2% (34 cases) vs. 11.8% (23 cases), P<0.01〕. There was no significant difference in minor or intracranial hemorrhagic events between the two age groups. Conclusions The elderly patients with non-valvular atrial fibrillation in China are inadequately treated with anticoagulation. High quality of anticoagulation significantly reduces thromboembolic events in the elderly patients, even in those above 75 years old, without increasing major bleeding events. Key words: Atrial fibrillation; Warfarin; Follow-up studies

GW26-e4601 Are 23-mm Cryoballoons Better than 28-mm Ones for the Treatment of Atrial Fibrillation in China?

GW26-e4601 Are 23-mm Cryoballoons Better than 28-mm Ones for the Treatment of Atrial Fibrillation in China?

The prognostic effects of ventricular heart rate among patients with permanent atrial fibrillation with and without coronary artery disease: a multicenter prospective observational study.

Heart rate control is important among patients with either atrial fibrillation (AF) or coronary artery disease (CAD). However, the relationship between the ventricular heart rate and adverse outcomes among patients with AF and CAD remains unclear. This study aimed to assess the prognostic effects of ventricular heart rate in patients with permanent AF (permAF) and CAD.We performed a multicenter, prospective, observational study of patients with AF in China. Patients≥18 years old with permAF were included and divided into a CAD group and a non-CAD group. All patients underwent 1 year of follow-up. The primary outcome was total mortality. Cox proportional hazard models were used to evaluate the relationship between risk factors and the survival rate in the study population.A total of 852 patients (69.1±12.7 years old, 43.3% male, 44.7% with CAD) were included in the analysis. Patients with CAD were older, were more likely to be male and exhibited higher prevalences of hypertension, diabetes mellitus, LV dysfunction, chronic obstructive pulmonary disease (COPD) and stroke compared with patients without CAD. During the follow-up period, a higher total mortality rate was noted in the CAD group than in the non-CAD group (21.5% vs 15.5%, P = 0.023). In the patients without CAD, the lowest quartile (≤76 beats/min) exhibited the best 1-year survival rate; however, in the patients with CAD, the highest quartile (>110 beats/min) exhibited the worst survival rate. Multivariate adjusted Cox analysis indicated that age (HR 1.039, 95% CI 1.025–1.055, P < 0.001) and heart rate (P = 0.004) were each independently associated with total mortality.Patients with CAD have more risk factors, and comorbidities and higher mortality rates than patients without CAD. In the patients with permAF without CAD, a ventricular rate of ≤76 beats/minute was associated with the best survival rate; however, among the patients with CAD, no increased mortality was observed unless the heart rate was >110 beats/min.