Seasonality, incidence and prognosis in atrial fibrillation and stroke in Denmark and New Zealand
- Anette Luther Christensen1,
- Lars Hvilsted Rasmussen1,2,
- Michael G Baker3,
- Gregory Y H Lip4,
- Claus Dethlefsen1,
- Torben Bjerregaard Larsen1,2
- 1Department of Cardiology, Aalborg AF Study Group, Center for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
- 2Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
- 3Department of Public Health, University of Otago, Wellington, New Zealand
- 4University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
- Correspondence to Anette Luther Christensen; anluc{at}rn.dk
- Received 23 March 2012
- Accepted 24 July 2012
- Published 24 August 2012
Abstract
Objectives There are relatively few large studies of seasonal variation in the occurrence of stroke in patients with atrial fibrillation (AF). We investigated the seasonal variation in incidence rates of hospitalisation with stroke in patients from Denmark and New Zealand.
Design Cohort study.
Setting Nationwide hospital discharge data from Denmark and New Zealand.
Participants 243 381 (median age 75) subjects having a first-time hospitalisation with AF in Denmark and 51 480 (median age 76) subjects in New Zealand constituted the study population. Subjects with previous hospitalisation with stroke were excluded.
Primary and secondary effect measures Peak-to-trough ratio of the seasonal variation in incidence rates of stroke in AF patients adjusted for an overall trend was primary effect measure and was assessed using a log-linear Poisson regression model. Secondary effect measures were incidence rate ratios of AF and 30-day case fatality for stroke patients.
Results Incidence rates of AF per 1000 person-years in Denmark increased by 5.4% (95% CI 5.3% to 5.7%) for patients aged <65 and 5% (95% CI 4.9% to 5.1%) for patients aged ≥65, whereas the increase was 0.2% (95% CI −0.2% to 0.6%) for patients aged <65 and 2.6% (95% CI 2.4% to 2.8%) for patients aged ≥65 in New Zealand. In Denmark 36 088 subjects were hospitalised with stroke, and 7518 subjects in New Zealand, both showing peaks during winter with peak-to-trough ratios of 1.22 and 1.27, respectively and a decreasing trend. The 30-day case fatality risk for stroke patients having AF is now (2000–2008) about 20% in both countries.
Conclusions Although incidence rates of hospitalisation with stroke in patients with AF have decreased in recent years, stroke remains a common AF complication with a high case fatality risk. The marked winter peak in incidence rates of hospitalisation with stroke in AF patients suggests that there are opportunities to reduce this complication. Further studies are necessary to identify how to optimise treatment of AF and prevention of stroke.
- Neurology
- Stroke
- Atrial fibrillation
- Seasonal variation
- Epidemiology
- Internal Medicine
- Cardiology
- Poisson regression
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