Risks of Death and Stroke in Patients Undergoing Hemodialysis with New-Onset Atrial Fibrillation: A Competing-Risk Analysis of a Nationwide Cohort

Chia Jen Shih, Shuo Ming Ou, Pei Wen Chao, Shu Chen Kuo, Yi Jung Lee, Chih Yu Yang, Der Cherng Tarng, Chih Ching Lin, Po Hsun Huang, Szu Yuan Li, Yung Tai Chen*

*此作品的通信作者

研究成果: Article同行評審

57 引文 斯高帕斯(Scopus)

摘要

Whether oral anticoagulant use should be considered in patients undergoing hemodialysis with atrial fibrillation (AF) remains controversial because of the uncertainty regarding risk-benefit assessments. The purpose of this study was to investigate the risk of ischemic stroke in patients undergoing hemodialysis with new-onset AF, in comparison with those without arrhythmia. Methods and Results-This nationwide, population-based, propensity score-matched cohort study used data from Taiwan's National Health Insurance Research Database during 1998 to 2011 for patients on hemodialysis with new-onset nonvalvular AF and matched subjects without arrhythmia. The clinical end points were ischemic stroke (fatal or nonfatal), all-cause death, and other serious adverse cardiovascular events. In comparison with the matched cohort, patients with AF (n=6772) had higher risks of ischemic stroke (adjusted hazard ratio [aHR], 1.27; 95% confidence interval [CI], 1.13-1.43), all-cause death (aHR, 1.59; 95% CI, 1.52-1.67), in-hospital cardiovascular death (aHR, 1.83; 95% CI, 1.71-1.94), myocardial infarction (aHR, 1.33; 95% CI, 1.17-1.51), and hospitalization for heart failure (aHR, 1.90; 95% CI, 1.76-2.05). After considering in-hospital death as a competing risk, AF significantly increased the risk of heart failure (HR, 1.56; 95% CI, 1.45-1.68), but not those of ischemic stroke and myocardial infarction. Additionally, the predictive value of the CHA2DS2-VASc score for ischemic stroke was diminished in the competing-risk model. Conclusions-The risk of stroke was only modestly higher in patients undergoing hemodialysis with new-onset AF than in those without AF, and it became insignificant when accounting for the competing risk of in-hospital death.

原文English
頁(從 - 到)265-272
頁數8
期刊Circulation
133
發行號3
DOIs
出版狀態Published - 19 1月 2016

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