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

Hyunjean Jung, Pil Sung Yang, Jung Hoon Sung, Eunsun Jang, Hee Tae Yu, Tae Hoon Kim, Jae Sun Uhm, Jong Youn Kim, huinam pak, Moon Hyoung Lee, Gregory Y.H. Lip, Boyoung Joung

Research output: Contribution to journalArticle

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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 CHA 2 DS 2 -VASc stroke risk factors was 4.02 per 100 person-years, and approached to that of NVAF patients without HCM with CHA 2 DS 2 -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 CHA 2 DS 2 -VASc stroke risk factors was similar to that of those patients without HCM with CHA 2 DS 2 -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.

Original languageEnglish
Article number180747
Pages (from-to)285-293
Number of pages9
JournalThrombosis and Haemostasis
Volume119
Issue number2
DOIs
Publication statusPublished - 2019 Jan 1

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Hypertrophic Cardiomyopathy
Atrial Fibrillation
Cohort Studies
Stroke
Anticoagulants
National Health Programs
Embolism

All Science Journal Classification (ASJC) codes

  • Hematology

Cite this

Jung, Hyunjean ; Yang, Pil Sung ; Sung, Jung Hoon ; Jang, Eunsun ; Yu, Hee Tae ; Kim, Tae Hoon ; Uhm, Jae Sun ; Kim, Jong Youn ; pak, huinam ; Lee, Moon Hyoung ; Lip, Gregory Y.H. ; Joung, Boyoung. / Hypertrophic Cardiomyopathy in Patients with Atrial Fibrillation : Prevalence and Associated Stroke Risks in a Nationwide Cohort Study. In: Thrombosis and Haemostasis. 2019 ; Vol. 119, No. 2. pp. 285-293.
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title = "Hypertrophic Cardiomyopathy in Patients with Atrial Fibrillation: Prevalence and Associated Stroke Risks in a Nationwide Cohort Study",
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-na{\"i}ve 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 CHA 2 DS 2 -VASc stroke risk factors was 4.02 per 100 person-years, and approached to that of NVAF patients without HCM with CHA 2 DS 2 -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 CHA 2 DS 2 -VASc stroke risk factors was similar to that of those patients without HCM with CHA 2 DS 2 -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.",
author = "Hyunjean Jung and Yang, {Pil Sung} and Sung, {Jung Hoon} and Eunsun Jang and Yu, {Hee Tae} and Kim, {Tae Hoon} and Uhm, {Jae Sun} and Kim, {Jong Youn} and huinam pak and Lee, {Moon Hyoung} and Lip, {Gregory Y.H.} and Boyoung Joung",
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Hypertrophic Cardiomyopathy in Patients with Atrial Fibrillation : Prevalence and Associated Stroke Risks in a Nationwide Cohort Study. / Jung, Hyunjean; Yang, Pil Sung; Sung, Jung Hoon; Jang, Eunsun; Yu, Hee Tae; Kim, Tae Hoon; Uhm, Jae Sun; Kim, Jong Youn; pak, huinam; Lee, Moon Hyoung; Lip, Gregory Y.H.; Joung, Boyoung.

In: Thrombosis and Haemostasis, Vol. 119, No. 2, 180747, 01.01.2019, p. 285-293.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Hypertrophic Cardiomyopathy in Patients with Atrial Fibrillation

T2 - Prevalence and Associated Stroke Risks in a Nationwide Cohort Study

AU - Jung, Hyunjean

AU - Yang, Pil Sung

AU - Sung, Jung Hoon

AU - Jang, Eunsun

AU - Yu, Hee Tae

AU - Kim, Tae Hoon

AU - Uhm, Jae Sun

AU - Kim, Jong Youn

AU - pak, huinam

AU - Lee, Moon Hyoung

AU - Lip, Gregory Y.H.

AU - Joung, Boyoung

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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 CHA 2 DS 2 -VASc stroke risk factors was 4.02 per 100 person-years, and approached to that of NVAF patients without HCM with CHA 2 DS 2 -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 CHA 2 DS 2 -VASc stroke risk factors was similar to that of those patients without HCM with CHA 2 DS 2 -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.

AB - 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 CHA 2 DS 2 -VASc stroke risk factors was 4.02 per 100 person-years, and approached to that of NVAF patients without HCM with CHA 2 DS 2 -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 CHA 2 DS 2 -VASc stroke risk factors was similar to that of those patients without HCM with CHA 2 DS 2 -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.

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U2 - 10.1055/s-0038-1676818

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