Robert Murphy, Albertino Damasceno, Catriona Reddin, Graeme J Hankey, Helle K Iversen, Shahram Oveisgharan, Fernando Lanas, Anna Czlonkowska, Peter Langhorne, Adesola Ogunniyi, Mohammad Wasay, Zvonko Rumboldt, Conor Stephen Judge, Aytekin Oguz, Charles Mondo, Yaroslav Winter, Annika Rosengren, Nana Pogosova, Alvaro Avezum, Yongchai Nilanont, Ernesto Penaherrera, Denis Xavier, Patrio Lopez Jamarillo, Xingyu Wang, Salim Yusuf, Martin O'Donnell

Variations in the prevalence of Atrial Fibrillation, and in the strength of its association with Ischaemic Stroke, in countries with different Income-Levels. INTERSTROKE case-control study

  • Neurology
  • Neurology (clinical)
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Background The contribution of atrial fibrillation (AF) to the aetiology and burden of stroke may vary by country income-level. Aims: We examined differences in the prevalence of AF and describe variations in the magnitude of the association between AF and ischaemic stroke by country income-level. Methods In the INTERSTROKE case-control study, participants with acute first ischaemic 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 centre. Participants were grouped into high-income (HIC), upper middle-income (subdivided into two groups UMIC1, UMIC2) 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 ischaemic 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. Conclusions 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.

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