Vascular Health and Risk Management (Oct 2020)

Risk of Atrial Fibrillation, Ischemic Stroke and Cognitive Impairment: Study of a Population Cohort ≥65 Years of Age

  • Clua-Espuny JL,
  • Muria-Subirats E,
  • Ballesta-Ors J,
  • Lorman-Carbo B,
  • Clua-Queralt J,
  • Palà E,
  • Lechuga-Duran I,
  • Gentille-Lorente D,
  • Bustamante A,
  • Muñoz MA,
  • Montaner J

Journal volume & issue
Vol. Volume 16
pp. 445 – 454

Abstract

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Jose-Luis Clua-Espuny,1 Eulalia Muria-Subirats,2 Juan Ballesta-Ors,3 Blanca Lorman-Carbo,4 Josep Clua-Queralt,5 Elena Palà,6 Iñigo Lechuga-Duran,7 Delicia Gentille-Lorente,7 Alejandro Bustamante,8 Miguel Ángel Muñoz,9 Joan Montaner6 On Behalf of the AFRICAT Research Group1EAP Tortosa 1-Est, Institut Català Salut, Servei Atenció Primària, UUDD Terres De l’Ebre. Universidad Rovira I Virgili, Programa Doctorat, Tortosa, Spain; 2EAP Tortosa 1-Est, Institut Català Salut, SAP Terres De l’Ebre, España Universidad Rovira I Virgili. Programa Doctorat, Tortosa, Tarragona, Spain; 3EAP Tortosa 1-Est, Institut Català Salut, SAP Terres De l’Ebre, Universidad Rovira I Virgili. Programa Doctorat. Tortosa, Tarragona, Spain; 4EAP Tortosa 1-Est, Institut Català Salut, SAP Terres De l’Ebre, España Universidad Rovira I Virgili. Programa Doctorat. Tortosa, Tarragona, Spain; 5Universitat De Lleida, Lérida, Spain; 6Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR)-Universitat Autónoma De Barcelona, Barcelona, Spain; 7Servicio Cardiología, Hospital Virgen De La Cinta, Institut Català Salut Tortosa, Tarragona, Spain; 8Department of Neurology, Hospital Universitari Vall d’Hebron, Barcelona, Spain; 9Institut d’Investigació En Atenció Primària IDIAP Jordi Gol, Unitat De Suport a La Recerca De Barcelona, Barcelona, SpainCorrespondence: Jose-Luis Clua-EspunyEAP Tortosa 1-Est, Institut Català Salut, Servei Atenció Primària, UUDD Terres De l’Ebre. Universidad Rovira I Virgili, Programa Doctorat, CAP Temple, Carrilet Square s/Num. Tortosa, 43500, SpainTel +34 977 510018Fax +34 977 44 57 28Email [email protected]: To evaluate a model for calculating the risk of AF and its relationship with the incidence of ischemic stroke and prevalence of cognitive decline.Materials and Methods: It was a multicenter, observational, retrospective, community-based study of a cohort of general population ≥ 6ct 35 years, between 01/01/2016 and 31/12/2018. Setting: Primary Care. Participants: 46,706 people ≥ 65 years with an active medical history in any of the primary care teams of the territory, information accessible through shared history and without previous known AF. Interventions: The model to stratify the risk of AF (PI) has been previously published and included the variables sex, age, mean heart rate, mean weight and CHA2DS2VASc score. Main measurements: For each risk group, the incidence density/1000 person/years of AF and stroke, number of cases required to detect a new AF, the prevalence of cognitive decline, Kendall correlation, and ROC curve were calculated.Results: The prognostic index was obtained in 37,731 cases (80.8%) from lowest (Q1) to highest risk (Q4). A total of 1244 new AFs and 234 stroke episodes were diagnosed. Q3-4 included 53.8% of all AF and 69.5% of strokes in men; 84.2% of all AF and 85.4% of strokes in women; and 77.4% of cases of cognitive impairment. There was a significant linear correlation between the risk-AF score and the Rankin score (p < 0.001), the Pfeiffer score (p < 0.001), but not NIHSS score (p 0.150). The overall NNS was 1/19.Conclusion: Risk stratification allows identifying high-risk individuals in whom to intervene on modifiable risk factors, prioritizing the diagnosis of AF and investigating cognitive status.Keywords: vascular risk score, atrial arrhythmia, cerebrovascular disease, silent stroke, cognitive decline

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