Variations in the prevalence of atrial fibrillation, and in the strength of its association with ischemic stroke, in countries with different income levels: INTERSTROKE case

Variations in the prevalence of atrial fibrillation, and in the strength of its association with ischemic stroke, in countries with different income levels: INTERSTROKE case–control study

Published:2024-01-30 Issue: Volume: Page:
ISSN:1747-4930
Container-title:International Journal of Stroke
language:en
Short-container-title:International Journal of Stroke

Author:

Murphy Robert¹^ORCID,Damasceno Albertino²,Reddin Catriona¹,Hankey Graeme J³^ORCID,Iversen Helle K⁴⁵^ORCID,Oveisgharan Shahram⁶,Lanas Fernando⁷,Czlonkowska Anna⁸,Langhorne Peter⁹,Ogunniyi Adesola¹⁰,Wasay Mohammad¹¹^ORCID,Rumboldt Zvonko¹²,Judge Conor¹^ORCID,Oguz Aytekin¹³,Mondo Charles¹⁴,Winter Yaroslav¹⁵¹⁶,Rosengren Annika¹⁷,Pogosova Nana¹⁸,Avezum Alvaro¹⁹,Nilanont Yongchai²⁰^ORCID,Penaherrera Ernesto²¹,Xavier Denis²²,Lopez-Jaramillo Patricio²³,Wang Xingyu²⁴,Yusuf Salim²⁵^ORCID,O’Donnell Martin¹²⁵

Affiliation:

1. HRB Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland

2. Eduardo Mondlane University, Maputo, Mozambique

3. School of Medicine and Pharmacology, The University of Western Australia, Perth, WA, Australia

4. Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

5. Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

6. Rush Alzheimer’s Disease Research Center, Rush University Medical Center, Chicago, IL, USA

7. Faculty of Medicine, Universidad de La Frontera, Temuco, Chile

8. Institute of Psychiatry and Neurology, Warsaw, Poland

9. Academic Section of Geriatric Medicine, Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK

10. Division of Cardiovascular Medicine, Department of Medicine, University College Hospital, Ibadan, Nigeria

11. The Aga Khan University, Karachi, Pakistan

12. Department of Medicine, University of Split, Split, Croatia

13. Metabolic Syndrome Association, Istanbul, Turkey

14. Department of Cardiology, Kiruddu National Referral Hospital, Kampala, Uganda

15. Department of Neurology, Johannes Gutenberg University Mainz, Mainz, Germany

16. Department of Neurology, Philipps-University Marburg, Marburg, Germany

17. Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

18. National Medical Research Center of Cardiology Named After Academician E.I. Chazov, Moscow, Russia

19. Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil

20. Neurology Division, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

21. Department of Cardiology, Hospital Luis Vernaza, Guayaquil, Ecuador

22. St. John’s Research Institute, St. John’s Medical College, Bangalore, India

23. Fundacion Oftalmologica de Santander-Clinica Carlos Ardila Lulle (FOSCAL), Bucaramanga, Colombia

24. Laboratory of Human Genetics, Beijing Hypertension League Institute, Beijing, China

25. Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada

Abstract

Background: The contribution of atrial fibrillation (AF) to the etiology and burden of stroke may vary by country income level. Aims: We examined differences in the prevalence of AF and described variations in the magnitude of the association between AF and ischemic stroke by country income level. Methods: In the INTERSTROKE case–control study, participants with acute first ischemic stroke were recruited across 32 countries. We included 10,363 ischemic stroke cases and 10,333 community or hospital controls who were matched for age, sex, and center. Participants were grouped into high-income (HIC), upper-middle-income (subdivided into two groups—UMIC-1 and UMIC-2), and lower-middle-income (LMIC) countries, based on gross national income. We evaluated the risk factors for AF overall and by country income level, and evaluated the association of AF with ischemic stroke. Results: AF was documented in 11.9% (n = 1235) of cases and 3.2% (n = 328) of controls. Compared to HIC, the prevalence of AF was significantly lower in UMIC-2 (aOR 0.35, 95% CI 0.29–0.41) and LMIC (aOR 0.50, 95% CI 0.41–0.60) on multivariable analysis. Hypertension, female sex, valvular heart disease, and alcohol intake were stronger risk factors for AF in lower-income countries, and obesity a stronger risk factor in higher-income countries. The magnitude of association between AF and ischemic stroke was significantly higher in lower-income countries compared to higher-income countries. The population attributable fraction for AF and stroke varied by region and was 15.7% (95% CI 13.7–17.8) in HIC, 14.6% (95% CI 12.3–17.1) in UMIC-1, 5.7% (95% CI 4.9–6.7) in UMIC-2, and 6.3% (95% CI 5.3–7.3) in LMIC. Conclusion: Risk factors for AF vary by country income level. AF contributes to stroke burden to a greater extent in higher-income countries than in lower-income countries, due to a higher prevalence and despite a lower magnitude of odds ratio.

Funder

Swedish Research Council, Swedish Heart and Lung Foundation

Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network

European Research Council

Publisher

SAGE Publications

Subject

Neurology,Neurology (clinical)

Link

http://journals.sagepub.com/doi/pdf/10.1177/17474930241227783

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