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Performance of Atrial Fibrillation Burden Trends for Stroke Risk Stratification.

Publication ,  Journal Article
Piccini, JP; Stanelle, EJ; Johnson, CC; Hylek, EM; Kanwar, R; Lakkireddy, DR; Mittal, S; Peacock, J; Russo, AM; Soderlund, D; Hills, MT; Passman, RS
Published in: Circ Arrhythm Electrophysiol
November 2024

BACKGROUND: Atrial fibrillation (AF) is associated with an increased risk of stroke, yet the limitations of conventional monitoring have restricted our understanding of AF burden risk thresholds. Predictive algorithms incorporating continuous AF burden measures may be useful for predicting stroke. This study evaluated the performance of temporal AF burden trends as predictors of stroke from a large cohort with insertable cardiac monitors. METHODS: Using deidentified data from Optum Clinformatics Data Mart (2007-2019) linked with the Medtronic CareLink insertable cardiac monitor database, we identified patients with an insertable cardiac monitor for AF management (n=1197), suspected AF (n=1611), and cryptogenic stroke (n=2205). Daily AF burden was transformed into simple moving averages, and temporal AF burden trends were defined as the comparison of unique simple moving average pairs. Classification trees were used to predict ischemic stroke, and AF burden significance was quantified using bootstrapped mean variable importance. RESULTS: Of 5013 patients (age, 69.2±11.7 years; 50% male; CHA2DS2-VASc, 3.7±1.9) who met inclusion criteria, 869 had an ischemic stroke over 2 409 437 days total follow-up. Prior stroke or transient ischemic attack (variable importance, 13.13) was the number 1 predictor of future stroke followed by no prior diagnosis of AF (7.35) and AF burden trends in follow-up (2.59). Temporal proximity of AF and risk of stroke differed by device indication (simple moving averages: AF management, <8 days and suspected AF and cryptogenic stroke, 8-21 days). Together, baseline characteristics and AF burden trends performed optimally for the area under the receiver operating characteristic curve (0.73), specificity (0.70), and relative risk (5.00). CONCLUSIONS: AF burden trends may provide incremental prognostic value as leading indicators of stroke risk compared with conventional schemes.

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Published In

Circ Arrhythm Electrophysiol

DOI

EISSN

1941-3084

Publication Date

November 2024

Volume

17

Issue

11

Start / End Page

e012394

Location

United States

Related Subject Headings

  • Time Factors
  • Stroke
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Prognosis
  • Predictive Value of Tests
  • Middle Aged
  • Male
  • Ischemic Stroke
 

Citation

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Piccini, J. P., Stanelle, E. J., Johnson, C. C., Hylek, E. M., Kanwar, R., Lakkireddy, D. R., … Passman, R. S. (2024). Performance of Atrial Fibrillation Burden Trends for Stroke Risk Stratification. Circ Arrhythm Electrophysiol, 17(11), e012394. https://doi.org/10.1161/CIRCEP.123.012394
Piccini, Jonathan P., Evan J. Stanelle, Cody C. Johnson, Elaine M. Hylek, Rahul Kanwar, Dhanunjaya R. Lakkireddy, Suneet Mittal, et al. “Performance of Atrial Fibrillation Burden Trends for Stroke Risk Stratification.Circ Arrhythm Electrophysiol 17, no. 11 (November 2024): e012394. https://doi.org/10.1161/CIRCEP.123.012394.
Piccini JP, Stanelle EJ, Johnson CC, Hylek EM, Kanwar R, Lakkireddy DR, et al. Performance of Atrial Fibrillation Burden Trends for Stroke Risk Stratification. Circ Arrhythm Electrophysiol. 2024 Nov;17(11):e012394.
Piccini, Jonathan P., et al. “Performance of Atrial Fibrillation Burden Trends for Stroke Risk Stratification.Circ Arrhythm Electrophysiol, vol. 17, no. 11, Nov. 2024, p. e012394. Pubmed, doi:10.1161/CIRCEP.123.012394.
Piccini JP, Stanelle EJ, Johnson CC, Hylek EM, Kanwar R, Lakkireddy DR, Mittal S, Peacock J, Russo AM, Soderlund D, Hills MT, Passman RS. Performance of Atrial Fibrillation Burden Trends for Stroke Risk Stratification. Circ Arrhythm Electrophysiol. 2024 Nov;17(11):e012394.

Published In

Circ Arrhythm Electrophysiol

DOI

EISSN

1941-3084

Publication Date

November 2024

Volume

17

Issue

11

Start / End Page

e012394

Location

United States

Related Subject Headings

  • Time Factors
  • Stroke
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Prognosis
  • Predictive Value of Tests
  • Middle Aged
  • Male
  • Ischemic Stroke