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

Authors 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

Received 11 August 2020

Accepted for publication 2 October 2020

Published 28 October 2020 Volume 2020:16 Pages 445—454

DOI https://doi.org/10.2147/VHRM.S276477

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Professor Magnus Bäck


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 Group

1EAP 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, Spain

Correspondence: Jose-Luis Clua-Espuny
EAP 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, Spain
Tel +34 977 510018
Fax +34 977 44 57 28
Email jlclua@telefonica.net

Purpose: 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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