國家衛生研究院 NHRI:Item 3990099045/9455

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Title:	Risks of death and stroke in patients undergoing hemodialysis with new-onset atrial fibrillation: A competing-risk analysis of a nationwide cohort
Authors:	Shih, CJ;Ou, SM;Chao, PW;Kuo, SC;Lee, YJ;Yang, CY;Tarng, DC;Lin, CC;Huang, PH;Li, SY;Chen, YT
Contributors:	Division of Infectious Diseases
Abstract:	BACKGROUND: -Whether oral anticoagulant (OAC) use should be considered in patients undergoing hemodialysis with atrial fibrillation (AF) remains controversial due to uncertainty regarding risk-benefit assessments. The purpose of this study was to investigate the risk of ischemic stroke in patients undergoing hemodialysis with new-onset AF, compared with those without arrhythmia. METHODS AND RESULTS: -This nationwide, population-based, propensity score-matched cohort study used data from Taiwan's National Health Insurance Research Database during 1998-2011 for patients on hemodialysis with new-onset non-valvular AF and matched subjects without arrhythmia. The clinical endpoints were ischemic stroke (fatal or non-fatal), all-cause death, and other serious adverse cardiovascular events. Compared with the matched cohort, patients with AF (n = 6,772) had higher risks of ischemic stroke (adjusted hazard ratio [aHR] 1.27, 95% confidence interval [CI] 1.13-1.43), all-cause death (aHR 1.59, 95% CI 1.52-1.67), in-hospital cardiovascular death (aHR 1.83, 95% CI 1.71-1.94), myocardial infarction (aHR 1.33, 95% CI 1.17-1.51), and hospitalization for heart failure (aHR 1.90, 95% CI 1.76-2.05). After considering in-hospital death as a competing risk, AF significantly increased the risk of heart failure (HR 1.56, 95% CI 1.45-1.68), but not those of ischemic stroke and myocardial infarction. Additionally, the predictive value of the CHA2DS2-VASc score for ischemic stroke was diminished in the competing risk model. CONCLUSIONS: -The risk of stroke was only modestly higher in patients undergoing hemodialysis with new-onset AF than in those without AF, and it became insignificant when accounting for the competing risk of in-hospital death.
Date:	2016-01-19
Relation:	Circulation. 2016 Jan 19;133(3):265-272.
Link to:	http://dx.doi.org/10.1161/circulationaha.115.018294
JIF/Ranking 2023:	http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=NHRI&SrcApp=NHRI_IR&KeyISSN=0009-7322&DestApp=IC2JCR
Cited Times(WOS):	https://www.webofscience.com/wos/woscc/full-record/WOS:000368540900006
Cited Times(Scopus):	http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=84955647296
Appears in Collections:	[Shu-Chen Kuo] Periodical Articles

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