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Risk of subsequent atrial fibrillation high among patients with traumatic ICH

21 Apr 2017

Patients with traumatic intracranial haemorrhage (ICH) are at greater risk of subsequent atrial fibrillation (AF), a large-scale cohort study from Taiwan suggests.

The study used data from the National Health Insurance Research Database, including a total of 130,171 individuals with traumatic ICH (ICH cohort; mean age 56.3 years; 66.1 percent male). A comparison cohort consisting of a similar number of propensity-matched individuals without traumatic ICH (mean age 56.9 years; 65.7 percent male) was also established. None of the participants in either cohort had prior history of AF.

During the follow-up period, AF occurred with greater frequency in the ICH cohort than in the comparison cohort (4.24 vs 4.12 per 1,000 person-years). The mean follow-up durations were 4.36 and 5.35 years, respectively.

In multivariable Cox proportional hazard models, individuals with traumatic ICH were 1.25 (95 percent CI, 1.18 to 1.32) times as likely as those without traumatic ICH to develop AF (p<0.001). Adjustments were made for age, sex and all AF-associated comorbidities.

When analysis was stratified by sex and age, the incidence of AF was consistently higher in the ICH cohort. Compared with individuals without traumatic ICH and without comorbidities, those with both traumatic ICH and comorbidities showed the highest risk of AF. This risk was also higher than that observed in individuals with comorbidities only.

In light of the present data, “physicians should carefully evaluate and aggressively reduce the risks of AF in patients with traumatic ICH and provide appropriate education for these patients, particularly those with chronic comorbidities,” researchers said.

Defined as intracranial bleeding followed by moderate to severe traumatic brain injury, traumatic ICH is a major cause of death for young people and is associated with lifelong disability among those who survive. [Neuroepidemiology 2015;45:20–7; Epilepsia 2003;44(Suppl 10):2–10]

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Elvira Manzano, 5 days ago
Bisphosphonates have proven antifracture efficacy and remain to be the cornerstone of osteoporosis treatment. However, a drug holiday is of particular importance with bisphosphonates due to some signals with long-term use of the drug, including rare incidence of atypical femoral fracture (AFF) and osteonecrosis of the jaw (ONJ), says a leading endocrinologist at AFOS 2017.
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