Impact of age on thromboembolic events in patients with non-valvular atrial fibrillation

Yun Gi Kim; Jong Il Choi; Ki Yung Boo; Do Young Kim; Yeji Hong; Min Sun Kim; Kwang No Lee; Jaemin Shim; Jin Seok Kim; Young Hoon Kim

doi:10.1002/clc.23293

Impact of age on thromboembolic events in patients with non-valvular atrial fibrillation

Yun Gi Kim, Jong Il Choi, Ki Yung Boo, Do Young Kim, Yeji Hong, Min Sun Kim, Kwang No Lee, Jaemin Shim, Jin Seok Kim, Young Hoon Kim

Research output: Contribution to journal › Article › peer-review

13 Citations (Scopus)

Abstract

Background: Age is a well-established risk factor for thromboembolic events in patients with atrial fibrillation (AF). However, the mechanism underlying the association between age and thromboembolic events in AF remains unknown. Methods: The prognostic value of age as a risk factor for thromboembolic events was analyzed using data from the Korean National Health Insurance Service (NHIS). In a large-scale single-center registry, cardiac hemodynamic parameters were examined to elucidate the cause of increased risk of thromboembolic events in older patients. Results: NHIS sample cohort data including 5896 patients with AF revealed that the risk of thromboembolic complication differed significantly according to age despite equal CHA₂DS₂-VASc score. In the registry of 2801 patients, age showed significant correlations with left atrium (LA) diameter, LA volume, E/e′, pulmonary artery pressure, and LA appendage flow velocity. Older patients had a significantly higher prevalence of spontaneous echocontrast (odds ratio [OR] = 1.030; P <.001). Age (OR = 1.031; P <.001), E/e′ (OR = 1.065; P =.004), and LA appendage flow velocity (OR =.988; P =.009) were significant predictors for thromboembolic events in multivariate analyses. In data from the NHIS, CHA₂DS₂-VASc score did not outperform age to predict thromboembolic events. Conclusions: Age is a significant risk factor for thromboembolic events in patients with AF, and old age is associated with adverse cardiac hemodynamics. This study suggests that older patients with AF are at high risk of thromboembolic events regardless of CHA₂DS₂-VASc score.

Original language	English
Pages (from-to)	78-85
Number of pages	8
Journal	Clinical Cardiology
Volume	43
Issue number	1
DOIs	https://doi.org/10.1002/clc.23293
Publication status	Published - 2020 Jan 1

Bibliographical note

Funding Information:
A substantial proportion of ischemic stroke, transient ischemic attack (TIA), and systemic embolism are caused by atrial fibrillation (AF). The thromboembolic events in AF patients are associated with significantly increased morbidity and mortality. Significant efforts are made to identify high risk patients and prevent these catastrophic complications. The CHA2DS2-VASc scoring system is the most common system used to stratify risk of thromboembolic events. CHA2DS2-VASc score is calculated by summing seven components: congestive heart failure, hypertension, age, diabetes, previous stroke/TIA/systemic embolism, vascular disease, and sex category. For age, one point is given for age 65-74 and two points are given for patients equal or older than 75 years. The use of anticoagulation therapy to prevent thromboembolic events in patients with AF is guided by the CHA2DS2-VASc scoring system, and anticoagulation should be recommended to patients with CHA2DS2-VASc score ≥ 2. The CHA2DS2-VASc system can identify patients at low risk for thromboembolic events. However, CHA2DS2-VASc is not perfect and the C-statistic was 0.606 according to the Euro Heart Survey on AF. A previous study by Chao et al. showed that assigning additional points to those older than 50 years improved the C-statistic and enabled identification of low risk patients more precisely in East Asian patients. A recent study also demonstrated that age is the most powerful predictor of ischemic stroke in patients with AF. However, the mechanism underlying age as a dominant risk factor for thromboembolic events in patients with AF is not fully understood. We aimed to evaluate the relative importance of age as a risk factor for thromboembolic events and to elucidate the underlying pathophysiology of the association between age and thromboembolic events. We used both the Korean National Health Insurance Service (K-NHIS) sample cohort data and the Korea University Medical Center Anam Hospital radiofrequency catheter ablation (RFCA) registry (KUMC registry). The prognostic value of age as a risk factor for thromboembolic events was analyzed using data from the Korean National Health Insurance Service (NHIS). In a large-scale single-center registry, cardiac hemodynamic parameters were examined to elucidate the cause of increased risk of thromboembolic events in older patients.

Publisher Copyright:
© 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.

Keywords

age
atrial fibrillation
ischemic stroke
thromboembolic complication
transient ischemic attack

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1002/clc.23293

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@article{a8bf0b4c5a3f45fea333e87907d6e859,

title = "Impact of age on thromboembolic events in patients with non-valvular atrial fibrillation",

abstract = "Background: Age is a well-established risk factor for thromboembolic events in patients with atrial fibrillation (AF). However, the mechanism underlying the association between age and thromboembolic events in AF remains unknown. Methods: The prognostic value of age as a risk factor for thromboembolic events was analyzed using data from the Korean National Health Insurance Service (NHIS). In a large-scale single-center registry, cardiac hemodynamic parameters were examined to elucidate the cause of increased risk of thromboembolic events in older patients. Results: NHIS sample cohort data including 5896 patients with AF revealed that the risk of thromboembolic complication differed significantly according to age despite equal CHA2DS2-VASc score. In the registry of 2801 patients, age showed significant correlations with left atrium (LA) diameter, LA volume, E/e′, pulmonary artery pressure, and LA appendage flow velocity. Older patients had a significantly higher prevalence of spontaneous echocontrast (odds ratio [OR] = 1.030; P <.001). Age (OR = 1.031; P <.001), E/e′ (OR = 1.065; P =.004), and LA appendage flow velocity (OR =.988; P =.009) were significant predictors for thromboembolic events in multivariate analyses. In data from the NHIS, CHA2DS2-VASc score did not outperform age to predict thromboembolic events. Conclusions: Age is a significant risk factor for thromboembolic events in patients with AF, and old age is associated with adverse cardiac hemodynamics. This study suggests that older patients with AF are at high risk of thromboembolic events regardless of CHA2DS2-VASc score.",

keywords = "age, atrial fibrillation, ischemic stroke, thromboembolic complication, transient ischemic attack",

author = "Kim, {Yun Gi} and Choi, {Jong Il} and Boo, {Ki Yung} and Kim, {Do Young} and Yeji Hong and Kim, {Min Sun} and Lee, {Kwang No} and Jaemin Shim and Kim, {Jin Seok} and Kim, {Young Hoon}",

note = "Funding Information: A substantial proportion of ischemic stroke, transient ischemic attack (TIA), and systemic embolism are caused by atrial fibrillation (AF). The thromboembolic events in AF patients are associated with significantly increased morbidity and mortality. Significant efforts are made to identify high risk patients and prevent these catastrophic complications. The CHA2DS2-VASc scoring system is the most common system used to stratify risk of thromboembolic events. CHA2DS2-VASc score is calculated by summing seven components: congestive heart failure, hypertension, age, diabetes, previous stroke/TIA/systemic embolism, vascular disease, and sex category. For age, one point is given for age 65-74 and two points are given for patients equal or older than 75 years. The use of anticoagulation therapy to prevent thromboembolic events in patients with AF is guided by the CHA2DS2-VASc scoring system, and anticoagulation should be recommended to patients with CHA2DS2-VASc score ≥ 2. The CHA2DS2-VASc system can identify patients at low risk for thromboembolic events. However, CHA2DS2-VASc is not perfect and the C-statistic was 0.606 according to the Euro Heart Survey on AF. A previous study by Chao et al. showed that assigning additional points to those older than 50 years improved the C-statistic and enabled identification of low risk patients more precisely in East Asian patients. A recent study also demonstrated that age is the most powerful predictor of ischemic stroke in patients with AF. However, the mechanism underlying age as a dominant risk factor for thromboembolic events in patients with AF is not fully understood. We aimed to evaluate the relative importance of age as a risk factor for thromboembolic events and to elucidate the underlying pathophysiology of the association between age and thromboembolic events. We used both the Korean National Health Insurance Service (K-NHIS) sample cohort data and the Korea University Medical Center Anam Hospital radiofrequency catheter ablation (RFCA) registry (KUMC registry). The prognostic value of age as a risk factor for thromboembolic events was analyzed using data from the Korean National Health Insurance Service (NHIS). In a large-scale single-center registry, cardiac hemodynamic parameters were examined to elucidate the cause of increased risk of thromboembolic events in older patients. Publisher Copyright: {\textcopyright} 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.",

year = "2020",

month = jan,

day = "1",

doi = "10.1002/clc.23293",

language = "English",

volume = "43",

pages = "78--85",

journal = "Clinical Cardiology",

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number = "1",

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TY - JOUR

T1 - Impact of age on thromboembolic events in patients with non-valvular atrial fibrillation

AU - Kim, Yun Gi

AU - Choi, Jong Il

AU - Boo, Ki Yung

AU - Kim, Do Young

AU - Hong, Yeji

AU - Kim, Min Sun

AU - Lee, Kwang No

AU - Shim, Jaemin

AU - Kim, Jin Seok

AU - Kim, Young Hoon

N1 - Funding Information: A substantial proportion of ischemic stroke, transient ischemic attack (TIA), and systemic embolism are caused by atrial fibrillation (AF). The thromboembolic events in AF patients are associated with significantly increased morbidity and mortality. Significant efforts are made to identify high risk patients and prevent these catastrophic complications. The CHA2DS2-VASc scoring system is the most common system used to stratify risk of thromboembolic events. CHA2DS2-VASc score is calculated by summing seven components: congestive heart failure, hypertension, age, diabetes, previous stroke/TIA/systemic embolism, vascular disease, and sex category. For age, one point is given for age 65-74 and two points are given for patients equal or older than 75 years. The use of anticoagulation therapy to prevent thromboembolic events in patients with AF is guided by the CHA2DS2-VASc scoring system, and anticoagulation should be recommended to patients with CHA2DS2-VASc score ≥ 2. The CHA2DS2-VASc system can identify patients at low risk for thromboembolic events. However, CHA2DS2-VASc is not perfect and the C-statistic was 0.606 according to the Euro Heart Survey on AF. A previous study by Chao et al. showed that assigning additional points to those older than 50 years improved the C-statistic and enabled identification of low risk patients more precisely in East Asian patients. A recent study also demonstrated that age is the most powerful predictor of ischemic stroke in patients with AF. However, the mechanism underlying age as a dominant risk factor for thromboembolic events in patients with AF is not fully understood. We aimed to evaluate the relative importance of age as a risk factor for thromboembolic events and to elucidate the underlying pathophysiology of the association between age and thromboembolic events. We used both the Korean National Health Insurance Service (K-NHIS) sample cohort data and the Korea University Medical Center Anam Hospital radiofrequency catheter ablation (RFCA) registry (KUMC registry). The prognostic value of age as a risk factor for thromboembolic events was analyzed using data from the Korean National Health Insurance Service (NHIS). In a large-scale single-center registry, cardiac hemodynamic parameters were examined to elucidate the cause of increased risk of thromboembolic events in older patients. Publisher Copyright: © 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Background: Age is a well-established risk factor for thromboembolic events in patients with atrial fibrillation (AF). However, the mechanism underlying the association between age and thromboembolic events in AF remains unknown. Methods: The prognostic value of age as a risk factor for thromboembolic events was analyzed using data from the Korean National Health Insurance Service (NHIS). In a large-scale single-center registry, cardiac hemodynamic parameters were examined to elucidate the cause of increased risk of thromboembolic events in older patients. Results: NHIS sample cohort data including 5896 patients with AF revealed that the risk of thromboembolic complication differed significantly according to age despite equal CHA2DS2-VASc score. In the registry of 2801 patients, age showed significant correlations with left atrium (LA) diameter, LA volume, E/e′, pulmonary artery pressure, and LA appendage flow velocity. Older patients had a significantly higher prevalence of spontaneous echocontrast (odds ratio [OR] = 1.030; P <.001). Age (OR = 1.031; P <.001), E/e′ (OR = 1.065; P =.004), and LA appendage flow velocity (OR =.988; P =.009) were significant predictors for thromboembolic events in multivariate analyses. In data from the NHIS, CHA2DS2-VASc score did not outperform age to predict thromboembolic events. Conclusions: Age is a significant risk factor for thromboembolic events in patients with AF, and old age is associated with adverse cardiac hemodynamics. This study suggests that older patients with AF are at high risk of thromboembolic events regardless of CHA2DS2-VASc score.

AB - Background: Age is a well-established risk factor for thromboembolic events in patients with atrial fibrillation (AF). However, the mechanism underlying the association between age and thromboembolic events in AF remains unknown. Methods: The prognostic value of age as a risk factor for thromboembolic events was analyzed using data from the Korean National Health Insurance Service (NHIS). In a large-scale single-center registry, cardiac hemodynamic parameters were examined to elucidate the cause of increased risk of thromboembolic events in older patients. Results: NHIS sample cohort data including 5896 patients with AF revealed that the risk of thromboembolic complication differed significantly according to age despite equal CHA2DS2-VASc score. In the registry of 2801 patients, age showed significant correlations with left atrium (LA) diameter, LA volume, E/e′, pulmonary artery pressure, and LA appendage flow velocity. Older patients had a significantly higher prevalence of spontaneous echocontrast (odds ratio [OR] = 1.030; P <.001). Age (OR = 1.031; P <.001), E/e′ (OR = 1.065; P =.004), and LA appendage flow velocity (OR =.988; P =.009) were significant predictors for thromboembolic events in multivariate analyses. In data from the NHIS, CHA2DS2-VASc score did not outperform age to predict thromboembolic events. Conclusions: Age is a significant risk factor for thromboembolic events in patients with AF, and old age is associated with adverse cardiac hemodynamics. This study suggests that older patients with AF are at high risk of thromboembolic events regardless of CHA2DS2-VASc score.

KW - age

KW - atrial fibrillation

KW - ischemic stroke

KW - thromboembolic complication

KW - transient ischemic attack

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DO - 10.1002/clc.23293

M3 - Article

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AN - SCOPUS:85075363694

SN - 0160-9289

VL - 43

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JO - Clinical Cardiology

JF - Clinical Cardiology

IS - 1

ER -

Impact of age on thromboembolic events in patients with non-valvular atrial fibrillation

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

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