For the first time, researchers have mapped the rate at which stroke risks rise in younger patients who have atrial fibrillation but who didn’t need treatment when they were diagnosed. The research provides important information that could help doctors follow up these patients appropriately.
Atrial fibrillation (AF), a heart condition, is a strong risk factor for stroke, especially as people grow older. New technology in wearable devices and smartwatches means that heart rhythm disturbances like AF are being detected in more and more younger people, and GPs are seeing increasing numbers of AF patients under 65. Around half of these younger AF patients are classed as low risk and do not need treatment at the time of their diagnosis.
But the new research finds that this group is more likely than the general population to develop problems like hypertension, heart failure and diabetes, which increase stroke risk.
The new evidence should inform the clinical management of these patients in the years after their AF diagnosis. Monitoring people in this group would allow the risk factors to be managed and anticoagulation treatment to prevent stroke could be started promptly.
The research team, led by Professor Jonathan Mant at the University of Cambridge’s Primary Care Unit, studied the medical records of 8,990 people aged under 65 to find out how risk factors for stroke changed in the years after an AF diagnosis. The electronic records, all from England, were from a primary care database called the Clinical Practice Research Datalink (CPRD), which has been shown to be representative of the general population in England.
All the patients whose records were studied had been newly diagnosed with AF and had no other risk factors, so were not offered anticoagulation treatment. The records were followed until the patients developed new risk factors and became eligible for treatment or until they turned 65 years old. The researchers found that 1,688 patients (23%) developed a risk factor during follow up, at a rate of 6% every year. Hypertension and heart failure were the most common risk factors to occur, followed by new onset diabetes.
In the future AF will be increasingly detected by novel technologies embedded in wearable devices and more and more younger people are likely to be diagnosed. We hope that this new evidence will help determine how we should follow up stroke risk in people diagnosed with AF who do not meet the threshold for anticoagulation treatment.”
– Professor Jonathan Mant, Professor of Primary Care and research lead
The research was funded by the National Institute for Health and Care Research.
Mendonça SC, Edwards D, Lund J, Saunders CL, Mant J. Progression of stroke risk in atrial fibrillation: cohort study in general practice. BJGP 05 May 2023
Lucy Lloyd, Communications, Primary Care Unit