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Progression of stroke risk in patients aged <65 years diagnosed with atrial fibrillation: a cohort study in general practice

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Mendonca, SC 
Saunders, CL 


Background: Due to new technologies, more people with atrial fibrillation (AF) are likely to be diagnosed under the age of 65 years.
Aim: To investigate risk of someone diagnosed with AF aged <65 developing an indication for anticoagulation before they reach 65. Design and setting: Population based cohort study of patients from English practices using a primary care database of electronic medical records, the Clinical Practice Research Data Link (CPRD). Method: Patients aged <65 newly diagnosed with AF were included. The CHA2DS2-VASc score was derived at time of diagnosis based on patients’ medical records. Patients not eligible for anticoagulation were followed up until they became eligible or turned 65 years old. The primary outcome of interest was development of a risk factor for stroke in AF.
Results: Among 18,178 patients diagnosed with AF aged <65, 9,188 (51%) were eligible for anticoagulation at time of diagnosis. Among 8,990 ineligible, 1,688 (23%) developed a risk factor during follow up before turning 65 or leaving the cohort for other reasons, at a rate of 6.1 per 100 patient-years. Hypertension and heart failure were the most common risk factors to occur, with rates of 2.51 (95% CI 2.25-2.59) and 2.41 (95% CI 1.38-1.64) per 100 patient years respectively. Rate of new diabetes was 0.93 (95% CI 0.83-1.04) per 100 patient years Conclusion: People aged <65 with AF are at higher risk of developing hypertension, heart failure and diabetes than the general population, so may warrant regular review to identify new occurrence of such risk factors.



anticoagulation, atrial fibrillation, primary care, risk factors, stroke risk, Humans, Aged, Atrial Fibrillation, Cohort Studies, Risk Assessment, Stroke, Risk Factors, Diabetes Mellitus, Hypertension, Heart Failure, General Practice, Anticoagulants

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British Journal of General Practice

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Royal College of General Practitioners
European Commission Horizon 2020 (H2020) ERC (847770)
All authors report grants from the NIHR School of Primary Care Research, during the conduct of the study.