Abstract Number: PB2048
Meeting: ISTH 2020 Congress
Background: Atrial fibrillation (AF) disproportionately affects older adults and increases risk of stroke. Short-term consequences of stroke are well-described, but less is known about how stroke affects long-term outcomes in AF patients who have other risk factors for death and functional decline.
Aims: Determine if, and to what degree, stroke affects mortality and functional disability over time in older AF patients.
Methods: We used data from 1992-2014 from the Health and Retirement Study, a longitudinal, nationally representative survey of Americans linked to Medicare claims. Subjects were ≥ 65 years with AF who did not require help with 6 activities of daily living (ADLs) (e.g. dressing, bathing). We matched incident stroke patients with 5 nonstroke patients using time from AF diagnosis. Outcomes were time to death and dependence in any of 6 ADLs assessed at 2-year intervals. We used a competing risks survival analysis framework.
Results: We identified 184 subjects with stroke and 935 controls. Two years after stroke, 52% (95% CI 45-60%) of stroke patients had died versus 24% (95% CI 21-26%) of controls. By 4 years, 72% (95% CI 64-79%) of stroke patients had died versus 40% (95% CI 37-44%) of controls, and by 8 years, 91% (95% CI 85-96%) versus 64% (95% CI 60-67%). Cumulative incidence of ADL dependence at 2 years was 52% (95% CI 45-59%) for stroke patients versus 23% (95% CI 21-27%) for controls, at 4 years 66% (95% CI 59-73%) versus 40% (95% CI 36-43%) and at 8 years 78% (95% CI 71-83%) versus 59% (95% CI 56-63%).
Conclusions: In older AF patients, half of stroke patients died after 2 years, double the risk of those without stroke. Stroke was associated with significantly greater loss of functional independence over time. These results inform decision-making and patient counseling on anticoagulation and advance care planning.
To cite this abstract in AMA style:Parks A, Fang M, Jeon SY, Smith A, Steinman M, Shah S. Long-term Mortality and Functional Status in Older Adults with Atrial Fibrillation After Stroke [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/long-term-mortality-and-functional-status-in-older-adults-with-atrial-fibrillation-after-stroke/. Accessed October 1, 2023.
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