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Hypertrophic Cardiomyopathy in Patients with Atrial Fibrillation: Prevalence and Associated Stroke Risks in a Nationwide Cohort Study

Authors
 Hyunjean Jung  ;  Pil-Sung Yang   ;  Jung-Hoon Sung   ;  Eunsun Jang  ;  Hee Tae Yu  ;  Tae-Hoon Kim  ;  Jae-Sun Uhm  ;  Jong-Youn Kim  ;  Hui-Nam Pak  ;  Moon-Hyoung Lee  ;  Gregory Y. H. Lip  ;  Boyoung Joung  
Citation
 Thrombosis and Haemostasis, Vol.119(2) : 285-293, 2019 
Journal Title
 Thrombosis and Haemostasis 
ISSN
 0340-6245 
Issue Date
2019
MeSH
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anticoagulants/therapeutic use* ; Atrial Fibrillation/complications ; Atrial Fibrillation/epidemiology* ; Brain Ischemia/etiology* ; Cardiomyopathy, Hypertrophic/complications ; Cardiomyopathy, Hypertrophic/epidemiology* ; Cohort Studies ; Comorbidity ; Female ; Heart Failure ; Humans ; Ischemia ; Male ; Middle Aged ; Prevalence ; Republic of Korea ; Risk Factors ; Stroke/epidemiology ; Stroke/etiology* ; Thromboembolism/complications ; Treatment Outcome ; Young Adult
Abstract
BACKGROUND:  There have been no prior nationwide reports on the prevalence of hypertrophic cardiomyopathy (HCM) among patients suffering from atrial fibrillation (AF). It is also unclear how much stroke risk is attributable to HCM compared with other stroke risks in patients with AF. This study assessed the prevalence of HCM among non-valvular AF (NVAF) patients and to assess the magnitude of increase in stroke risk in NVAF patients with HCM, compared with those without HCM. PATIENTS AND METHODS:  From the Korean National Health Insurance Service database from January 1, 2005 to December 31, 2016, we analysed 979,784 patients with prevalent NVAF aged 18 years or older. RESULTS:  The overall HCM prevalence in NVAF patients was 1.1%. Although HCM in these patients is an absolute indication for oral anticoagulant (OAC) prescription, only 1,622 (15.3%) patients were receiving OAC at the time of AF diagnosis. Among OAC-naïve patients with NVAF, compared with those without HCM, those with HCM had the increased risk of ischaemic stroke/systemic embolism with clinical variable adjusted hazard ratio of 1.55 (95% confidential interval, 1.48-1.63; p < 0.001). Ischaemic stroke/systemic embolism rate of NVAF patients with HCM without any non-gender CHA2DS2-VASc stroke risk factors was 4.02 per 100 person-years, and approached to that of NVAF patients without HCM with CHA2DS2-VASc score of 3 (4.07 per 100 person-years). CONCLUSION:  Among all NVAF patients, 1.1% of patient has HCM. The risk of stroke in NVAF with HCM without any CHA2DS2-VASc stroke risk factors was similar to that of those patients without HCM with CHA2DS2-VASc score of 3. Despite this, the actual use of OACs among NVAF patients with HCM was sub-optimal, relative to their high stroke risk.
Full Text
http://www.thieme-connect.com/DOI/DOI?10.1055/s-0038-1676818
DOI
10.1055/s-0038-1676818
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jong Youn(김종윤) ORCID logo https://orcid.org/0000-0001-7040-8771
Kim, Tae-Hoon(김태훈) ORCID logo https://orcid.org/0000-0003-4200-3456
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Yu, Hee Tae(유희태) ORCID logo https://orcid.org/0000-0002-6835-4759
Lee, Moon Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/171441
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