Temporal trends in ischemic stroke and anticoagulation therapy for non‐valvular atrial fibrillation: effect of diabetes1: 非瓣膜性心房颤动患者缺血性脑卒中以及抗凝治疗的时间趋势:糖尿病的影响. (13th April 2016)

• Record Type: Journal Article
• Authors: Shroff, Gautam R.; Solid, Craig A.; Bloomgarden, Zachary; Halperin, Jonathan L.; Herzog, Charles A.
• Is Part Of: Journal of diabetes. Volume 9:Number 2(2017:Apr.)
• Page Start: 115
• Page End: 122
• Publication Date: 2016-04-13
• Subjects: anticoagulation -- atrial fibrillation -- diabetes mellitus -- stroke; ; Diabetes -- Periodicals; 618.3646005
• DOI: 10.1111/1753-0407.12392
• Languages: English
• ISSNs: 1753-0393

Abstract

Abstract: Background: Diabetes is an important risk factor for ischemic stroke in non‐valvular atrial fibrillation (AF). The aim of the present study was to evaluate temporal trends in ischemic stroke and warfarin use among US Medicare patients with and without diabetes. Methods: In this retrospective cohort study, 1‐year cohorts of patients with Medicare as the primary payer over the period 1992–2010 were created using the Medicare 5% sample (excluding patients with valvular disease and end‐stage renal disease). International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) codes were used to identify AF, ischemic and hemorrhagic stroke, and diabetes; three or more consecutive prothrombin time claims were used to identify warfarin use. Results: Demographic characteristics of subjects in 1992 ( n = 40 255) and 2010 ( n = 80 314), respectively, were as follows: age 65–74 years, 37% and 32%; age >85 years, 20% and 25%; White, 94% and 93%; hypertension, 46% and 80%; diabetes, 20% and 32%; and chronic kidney disease, 5% and 18%. Among Medicare AF patients with diabetes, ischemic stroke decreased by 71% (1992–2010) from 65 to 19 per 1000 patient‐years; warfarin use increased from 28% to 62%. Among patients without diabetes, ischemic stroke decreased by 68% from 44 to 14 per 1000 patient‐years, whereas warfarin use increased from 26% to 59%. Approximately 38% of Medicare AF patients with diabetes did not receive anticoagulation in 2010. Conclusions: Ischemic stroke declined and warfarin use increased similarly in Medicare patients with and without diabetes. Ischemic stroke rates were consistently higher in diabetes patients, validating the inclusion of diabetes in risk calculators. The population of Medicare patients with diabetes who did not receive warfarin deserves future attention. Highlights: Consistent decrease over two decades in ischemic stroke rates among US Medicare atrial fibrillation patients with and without diabetes. Reduction in ischemic stroke rates occurred coincident with increase in warfarin use, but also occurred among non-anticoagulated patients. A significant proportion of US Medicare patients with atrial fibrillation and diabetes did not receive anticoagulation with warfarin in 2010. Trends in ischemic stroke among US Medicare patients with atrial fibrillation, with A or without B diabetes mellitus after starting warfarin compared with patients not using warfarin. Data are stroke rates per 1000 patient‐years with standard error of the estimate.