We propose to continue our studies of a uniquely informative cohort of greater than 13,559 patients with atrial fibrillation (AF) from Kaiser Medical Care Program of Northern California (""""""""Kaiser""""""""). Our overall goal remains to optimize prevention of stroke in AF by improving selection of patients treated with anticoagulants, and by improving the management of anticoagulation. AF is the most common significant cardiac rhythm disorder. Its frequency increases strikingly with age, reaching a prevalence of nearly 10 percent in those over age 80. AF is also a powerful risk factor for stroke, raising this risk 5-fold. Randomized trials (RCTs) have established that anticoagulation largely removes the stroke risk posed by AF. Nonetheless, warfarin remains a burdensome and risky therapy. There is considerable uncertainty whether warfarin therapy will prove beneficial under real-world conditions. Guidelines call for long-term anticoagulation, and for use of anticoagulants in the elderly. Yet, the RCTs were relatively brief, with a mean follow-up of only 18 months, and few patients greater than or equal to 80 years old were studied. During the 2.7 years of current funding we have established methods to assemble a very large AF cohort, characterize baseline features and warfarin status, and follow for thromboembolic and hemorrhagic events. This has been accomplished efficiently via comprehensive automated clinical and administrative Kaiser databases supplemented by medical chart review. Continued follow-up of our AF cohort will provide unique assessments of both the long-term impact of anticoagulation and the impact of anticoagulation among the oldest patients with AF. Further, we will be able to address other important controversies including the need for anticoagulation in patients greater than or equal to 65 years old without other risk factors for stroke, and the optimal intensity of anticoagulation in older AF patients. In addition, we will address the provocative new finding that estrogen replacement therapy substantially raises the risk of stroke among women with AF. In all, continued study of our cohort will efficiently provide powerful insights into optimizing stroke prevention strategies for the many older Americans with AF.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG015478-07
Application #
6721156
Study Section
Epidemiology and Disease Control Subcommittee 2 (EDC)
Program Officer
Nayfield, Susan G
Project Start
1997-09-30
Project End
2006-03-31
Budget Start
2004-05-01
Budget End
2005-03-31
Support Year
7
Fiscal Year
2004
Total Cost
$839,620
Indirect Cost
Name
Massachusetts General Hospital
Department
Type
DUNS #
073130411
City
Boston
State
MA
Country
United States
Zip Code
02199
Ashburner, Jeffrey M; Go, Alan S; Chang, Yuchiao et al. (2017) Influence of Competing Risks on Estimating the Expected Benefit of Warfarin in Individuals with Atrial Fibrillation Not Currently Taking Anticoagulants: The Anticoagulation and Risk Factors in Atrial Fibrillation Study. J Am Geriatr Soc 65:35-41
McGrath, Emer R; Go, Alan S; Chang, Yuchiao et al. (2017) Use of Oral Anticoagulant Therapy in Older Adults with Atrial Fibrillation After Acute Ischemic Stroke. J Am Geriatr Soc 65:241-248
Quinn, Gene R; Singer, Daniel E; Chang, Yuchiao et al. (2016) How Well Do Stroke Risk Scores Predict Hemorrhage in Patients With Atrial Fibrillation? Am J Cardiol 118:697-9
Ashburner, Jeffrey M; Go, Alan S; Chang, Yuchiao et al. (2016) Effect of Diabetes and Glycemic Control onĀ Ischemic Stroke Risk in AF Patients: ATRIA Study. J Am Coll Cardiol 67:239-47
Dallalzadeh, Liane O; Go, Alan S; Chang, Yuchiao et al. (2016) Stability of High-Quality Warfarin Anticoagulation in a Community-Based Atrial Fibrillation Cohort: The Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. J Am Heart Assoc 5:
Ashburner, Jeffrey M; Go, Alan S; Reynolds, Kristi et al. (2015) Comparison of frequency and outcome of major gastrointestinal hemorrhage in patients with atrial fibrillation on versus not receiving warfarin therapy (from the ATRIA and ATRIA-CVRN cohorts). Am J Cardiol 115:40-6
Quinn, Gene R; Singer, Daniel E; Chang, Yuchiao et al. (2014) Effect of selective serotonin reuptake inhibitors on bleeding risk in patients with atrial fibrillation taking warfarin. Am J Cardiol 114:583-6
Fang, Margaret C; Go, Alan S; Chang, Yuchiao et al. (2014) Long-term survival after ischemic stroke in patients with atrial fibrillation. Neurology 82:1033-7
Singer, Daniel E; Chang, Yuchiao; Borowsky, Leila H et al. (2013) A new risk scheme to predict ischemic stroke and other thromboembolism in atrial fibrillation: the ATRIA study stroke risk score. J Am Heart Assoc 2:e000250
Fang, Margaret C; Go, Alan S; Chang, Yuchiao et al. (2012) Thirty-day mortality after ischemic stroke and intracranial hemorrhage in patients with atrial fibrillation on and off anticoagulants. Stroke 43:1795-9

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