PT  - JOURNAL ARTICLE
AU  - Toshiki Maeda
AU  - Takumi Nishi
AU  - Shunsuke Funakoshi
AU  - Kazuhiro Tada
AU  - Masayoshi Tsuji
AU  - Atsushi Satoh
AU  - Miki Kawazoe
AU  - Chikara Yoshimura
AU  - Hisatomi Arima
TI  - Residual risks of ischaemic stroke and systemic embolism among atrial fibrillation patients with anticoagulation: large-scale real-world data (F-CREATE project)
AID  - 10.1136/heartjnl-2020-317299
DP  - 2021 Feb 01
TA  - Heart
PG  - 217--222
VI  - 107
IP  - 3
4099  - http://heart.bmj.com/content/107/3/217.short
4100  - http://heart.bmj.com/content/107/3/217.full
SO  - Heart2021 Feb 01; 107
AB  - Objective Among patients with atrial fibrillation, the risks of ischaemic stroke and systemic embolism (IS/SE) are high even with effective anticoagulation. Using large-scale, real-world data from Japan, this study aims to clarify residual risks of IS/SE attributable to modifiable risk factors among patients with atrial fibrillation who are taking oral anticoagulants.Methods The study design we employed was a retrospective cohort. Health check-ups and insurance claims data of Japanese health insurance companies were accumulated from January 2005 to June 2017. We identified 11 848 participants with atrial fibrillation who were on oral anticoagulants during the study period. We set the modifiable risk factors as hypertension, diabetes and dyslipidaemia. A Cox proportional hazards model was used to obtain the effects of the risk factors for IS/SE.Results During an average of 3 years’ follow-up, 200 cases of IS/SE occurred (incidence rate 0.57 per 100 person-years). In multivariable analyses, older age (65–74 vs <65 years; adjusted HR 2.02 (95% CI 1.49 to 2.73)), hypertension (adjusted HR 1.41 (1.04 to 1.92)) and dyslipidaemia (adjusted HR 1.46 (1.07 to 1.98)) were significantly associated with increased risk of IS/SE. Percentage of IS/SE risk attributable to modifiable risk factors (hypertension, diabetes and dyslipidaemia) was 30.0% (16.1% to 41.6%).Conclusion Among patients with atrial fibrillation on anticoagulant therapy, approximately one-third of the residual risks were estimated to be attributable to modifiable risk factors such as hypertension, diabetes and dyslipidaemia.