Incidence and functional outcome of atrial fibrillation and non-atrial fibrillation- related cardioembolic stroke in Joinville, Brazil: a population-based study

Claudio Henrique do Amaral; Augusto R. Amaral; Vivian Nagel; Vanessa Venancio; Adriana Coronetti Garcia; Pedro SC Magalhaes; Alexandre L Longo; Carla HC Moro; Felipe I Reis; Andre D’Avila; Norberto L Cabral

doi:10.1590/0004-282X20170039

Arquivos de Neuro-Psiquiatria, Table of Contents

CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2017; 75(05): 288-294
DOI: 10.1590/0004-282X20170039

ARTICLES

Incidence and functional outcome of atrial fibrillation and non-atrial fibrillation- related cardioembolic stroke in Joinville, Brazil: a population-based study

Incidência e desfecho funcional de AVC cardioembólico com e sem fibrilação atrial em Joinville, Brazil: estudo de base populacional

Claudio Henrique do Amaral

¹Universidade da Região de Joinville, Joinville SC, Brasil;

²Registro de AVC de Joinville, Joinville SC, Brasil;

,

Augusto R. Amaral

¹Universidade da Região de Joinville, Joinville SC, Brasil;

,

Vivian Nagel

²Registro de AVC de Joinville, Joinville SC, Brasil;

,

Vanessa Venancio

²Registro de AVC de Joinville, Joinville SC, Brasil;

,

Adriana Coronetti Garcia

²Registro de AVC de Joinville, Joinville SC, Brasil;

,

Pedro SC Magalhaes

²Registro de AVC de Joinville, Joinville SC, Brasil;

³Clinica Neurologica de Joinville, Joinville SC, Brasil;

,

Alexandre L Longo

³Clinica Neurologica de Joinville, Joinville SC, Brasil;

,

Carla HC Moro

³Clinica Neurologica de Joinville, Joinville SC, Brasil;

,

Felipe I Reis

²Registro de AVC de Joinville, Joinville SC, Brasil;

,

Andre D’Avila

⁴Hospital SOS Cardio, Florianópolis SC, BRasil.

,

Norberto L Cabral

¹Universidade da Região de Joinville, Joinville SC, Brasil;

²Registro de AVC de Joinville, Joinville SC, Brasil;

› Author Affiliations

Abstract

ABSTRACT

Among ischemic strokes, cardioembolic (CE) stroke has the worst outcome. We measured the incidence of atrial fibrillation (AF) and non-AF related CE strokes, previous anticoagulant use, and the 90-day functional outcome. Using multiple overlapping sources, we included all CE strokes that occurred in 2015 in Joinville, Brazil. Of the 374 ischemic strokes, 23% (84) were CE. The CE age-adjusted incidence, per 1,000 person-years, was 0.14 (0.11–0.17). Of the 26 patients with known prior AF, 73% (19) were not anticoagulated, 77% (20) had a CHA₂DS₂VASc score ≥ 3 and 81% (21) had a HAS-BLED score < 3. After three months, approximately one third of those 26 patients died or became disabled. The incidence of CE stroke in our sample was lower than in other population-based studies. The opportunity for anticoagulation was missed in one third of cases.

RESUMO

Entre todos os subtipos de AVC isquêmico, os eventos cardioembólicos (CE) apresentam os piores prognósticos. Determinamos a incidência de AVC isquêmico CE, associada ou não à fibrilação atrial (FA), o uso prévio de anticoagulantes e os desfechos funcionais em Joinville, Brasil. Utilizando múltiplas e sobrepostas fontes de informação, registramos todos os primeiros eventos CE ocorridos em 2015. Entre 374 eventos isquêmicos, 23% (84) foram CE. A incidência ajustada, para qualquer fonte cardioembólica, foi 0.14 (0.11–0.17) por 1000 pessoas-ano. Entre 26 pacientes com FA previamente conhecida, 73% (19) não estavam anticoagulados, 77% (20) tinham ≥ 3 pontos na escala CHA₂DS₂VASc e 81 % (21) < 3 pontos na escala HAS-BLED. Após 3 meses, um terço destes 26 pacientes morreram ou ficaram dependentes. A incidência de AVC I CE em Joinville é menor do que em outros estudos de base populacional. Um terço dos casos de AVC I CE com FA previamente conhecida perderam a oportunidade de anticoagulação.

stroke - incidence - prognosis - population studies in public health

acidente cerebral vascular - incidência - prognóstico - estudos populacionais em saúde pública

Full Text

References

References
1 Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009;8(4):355-69. https://doi.org/10.1016/S1474-4422(09)70025-0
2 Li L, Yiin GS, Geraghty OC, Schulz UG, Kuker W, Mehta Z et al. Incidence, outcome, risk factors, and long-term prognosis of cryptogenic transient ischaemic attack and ischaemic stroke: a population-based study. Lancet Neurol. 2015;14(9):903-13. https://doi.org/10.1016/S1474-4422(15)00132-5
3 Leyden JM, Kleinig TJ, Newbury J, Castle S, Cranefield J, Anderson CS et al. Adelaide stroke incidence study: declining stroke rates but many preventable cardioembolic strokes. Stroke. 2013;44(5):1226-31. https://doi.org/10.1161/STROKEAHA.113.675140
4 Hajat C, Heuschmann PU, Coshall C, Padayachee S, Chambers J, Rudd AG et al. Incidence of aetiological subtypes of stroke in a multi-ethnic population based study: the South London Stroke Register. J Neurol Neurosurg Psychiatry. 2011;82(5):527-33. https://doi.org/10.1136/jnnp.2010.222919
5 Palm F, Urbanek C, Wolf J, Buggle F, Kleemann T, Hennerici MG et al. Etiology, risk factors and sex differences in ischemic stroke in the Ludwigshafen Stroke Study, a population-based stroke registry. Cerebrovasc Dis. 2012;33(1):69-75. https://doi.org/10.1159/000333417
6 Béjot Y, Ben Salem D, Osseby GV, Couvreur G, Durier J, Marie C et al. Epidemiology of ischemic stroke from atrial fibrillation in Dijon, France, from 1985 to 2006. Neurology. 2009;72(4):346-53. https://doi.org/10.1212/01.wnl.0000341280.31919.bd
7 Yiin GS, Howard DP, Paul NL, Li L, Mehta Z, Rothwell PM et al. Recent time trends in incidence, outcome and premorbid treatment of atrial fibrillation-related stroke and other embolic vascular events: a population-based study. J Neurol Neurosurg Psychiatry. 2015;88(1):12-7. https://doi.org/10.1136/jnnp-2015-311947
8 Feigin VL, Krishnamurthi RV, Parmar P, Norrving B, Mensah GA, Bennett DA et al. Update on the global burden of ischemic and hemorrhagic stroke in 1990-2013: the GBD 2013 study. Neuroepidemiology. 2015;45(3):161-76. https://doi.org/10.1159/000441085
9 Strong K, Mathers C, Bonita R. Preventing stroke: saving lives around the world. Lancet Neurol. 2007;6(2):182-7. https://doi.org/10.1016/S1474-4422(07)70031-5
10 Instituto Brasileiro de Geografia e Estatística- IBGE. Censo 2010: resultados. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2015 [cited 2017 Apr 2]. Available from: http://censo2010.ibge.gov.br/resultados
11 Prefeitura Municipal de Joinville. Lei Nº 7.448, de 12 de junho de 2013. Insitui o banco de dados Registro de Acidente Vascular Cerebral – AVC de Joinville e dá outras providências. Joinville: Prefeitura Municipal; 2013 [cited 2015 Aug 20]. Available from: https://leismunicipais.com.br/a/sc/j/joinville/lei-ordinaria/2013/745/7448/lei-ordinaria-n-7448-2013-institui-o-banco-de-dados-registro-de-acidente-vascular-cerebral-avc-de-joinville-e-da-outras-providencias
12 Cabral NL, Gonçalves ARR, Longo AL, Moro CHC, Costa G, Amaral CH et al. Trends in stroke incidence, mortality and case fatality rates in Joinville, Brazil: 1995-2006. J Neurol Neurosurg Psychiatry. 2009;80(7):749-54. https://doi.org/10.1136/jnnp.2008.164475
13 Truelsen T, Heuschmann PU, Bonita R, Arjundas G, Dalal P, Damasceno A et al. Standard method for developing stroke registers in low-income and middle-income countries: experiences from a feasibility study of a stepwise approach to stroke surveillance (STEPS Stroke). Lancet Neurol. 2007;6(2):134-9. https://doi.org/10.1016/S1474-4422(06)70686-X
14 Ferro JM. Cardioembolic stroke: an update. Lancet Neurol. 2003;2(3):177-88. https://doi.org/10.1016/S1474-4422(03)00324-7
15 Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35-41. https://doi.org/10.1161/01.STR.24.1.35
16 Oliveira-Filho J, Martins SC, Pontes-Neto OM, Longo A, Evaristo EF, Carvalho JJ et al. Guidelines for acute ischaemic stroke treatment: part I. Arq Neuropsiquiatr. 2012;70(8):621-9. https://doi.org/10.1590/S0004-282X2012000800012
17 Associação Brasileira de Empresas de Pesquisa. http://www.abep.org. [cited 2016 Jan 4].
18 Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010;137(2):263-72. https://doi.org/10.1378/chest.09-1584
19 Pisters R, Lane DA, Nieuwlaat R, Vos CB, Crijns HJ, Lip GY. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010;138(5):1093-100. https://doi.org/10.1378/chest.10-0134
20 Nice Guidance. Atrial fibrillation: the management of atrial fibrillation. London: Nice; 2006 [cited 2016 Jan 10]. Available from: http://guidanceniceorguk/CG36 ; June 2014.
21 Sulter G, Steen C, De Keyser J. Use of the Barthel index and modified Rankin scale in acute stroke trials. Stroke 1999;30(8):1538-41. https://doi.org/10.1161/01.STR.30.8.1538
22 Ahmad OB, Boschi-Pinto C, Lopez AD, Murray CJL, Lozano L, Inoue M. Age standardization of rates: a new WHO standard. Geneva: World Health Organization; 2001.
23 Hannon N, Sheehan O, Kelly L, Marnane M, Merwick A, Moore A et al Stroke associated with atrial fibrillation: incidence and early outcomes in the north Dublin population stroke study. Cerebrovasc Dis. 2009;29(1):43-9. https://doi.org/10.1159/000255973
24 Yiin GS, Howard DP, Paul NL, Li L, Luengo-Fernandez R, Bull LM et al. Age-specific incidence, outcome, cost and projected future burden of atrial fibrillation-related embolic vascular events: a population-based study. Circulation. 2014;130(15):1236-44. https://doi.org/10.1161/CIRCULATIONAHA.114.010942
25 Ogilvie IM, Newton N, Welner SA, Cowell W, Lip GY. Underuse of oral anticoagulants in atrial fibrillation: a systematic review. Am J Med. 2010;123(7):638-45 e4. https://doi.org/10.1016/j.amjmed.2009.11.025
26 Cabral NL, Volpato D, Ogata TR, Ramirez T, Moro C, Gouveia S. Fibrilação atrial crçnica, AVC e anticoagulação: sub-uso de warfarina? Arq Neuropsiquiatr. 2004;62(4):1016-21. https://doi.org/10.1590/S0004-282X2004000600016
27 Petty GW, Brown RD Jr, Whisnant JP, Sicks JD, O’Fallon WM, Wiebers DO. Ischemic stroke subtypes a population-based study of functional outcome, survival, and recurrence. Stroke. 2000;31(5):1062-8. https://doi.org/10.1161/01.STR.31.5.1062
28 Lavados PM, Sacks C, Prina L, Escobar A, Tossi C, Araya F et al. Incidence, case-fatality rate, and prognosis of ischaemic stroke subtypes in a predominantly Hispanic-Mestizo population in Iquique, Chile (PISCIS project): a community-based incidence study. Lancet Neurol. 2007;6(2):140-8. https://doi.org/10.1016/S1474-4422(06)70684-6
29 Baggio, JA, Santos-Pontelli TE, Cougo-Pinto PT, Camilo M, Silva NF, Antunes P et al. Validation of a structured interview for telephone assessment of the modified Rankin Scale in Brazilian stroke patients. Cerebrovasc Dis. 2014;38(4):297-301. https://doi.org/10.1159/000367646