• Mais Al-Kawaz, Setareh S Omran, Neal S Parikh, Elkind Mitchell S V MSV Department of Neurology, College of Physicians and Surgeons, Winston-Salem, North Carolina; Department of Epidemiology, Mailman School of Public H, Elsayed Z Soliman, and Hooman Kamel.
• Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, New York; Department of Neurology, Weill Cornell Medicine, New York, New York. Electronic address: maa2067@nyp.org.
• J Stroke Cerebrovasc Dis. 2018 Apr 1; 27 (4): 839-844.

IntroductionThe aim of this study was to compare the risk of ischemic stroke in patients who have atrial fibrillation and patients who have atrial flutter.MethodsUsing inpatient and outpatient Medicare claims data from 2008 to 2014 for a 5% sample of all beneficiaries 66 years of age or older, we identified patients diagnosed with atrial fibrillation and those diagnosed with atrial flutter. The primary outcome was ischemic stroke. In the primary analysis, patients with atrial flutter were censored upon converting to fibrillation; in a secondary analysis, they were not. Survival statistics were used to compare incidence of stroke in patients with flutter and patients with fibrillation. Cox proportional hazards analysis was used to compare the associations of flutter and fibrillation with ischemic stroke after adjustment for demographics and risk factors.ResultsWe identified 14,953 patients with flutter and 318,138 with fibrillation. During a mean follow-up period of 2.8 (±2.3) years, we identified 18,900 ischemic strokes. The annual incidence of ischemic stroke in patients with flutter was 1.38% (95% confidence interval [CI] 1.22%-1.57%) compared with 2.02% (95% CI 1.99%-2.05%) in patients with fibrillation. After adjustment for demographics and stroke risk factors, flutter was associated with a lower risk of stroke compared with fibrillation (hazard ratio .69; 95% CI .60-.79, P < .05). Within 1 year, 65.7% (95% CI 64.9%-66.4%) of patients with flutter converted to fibrillation but remained at a lower risk of ischemic stroke (hazard ratio .85; 95% CI .78-.92).ConclusionsPatients with atrial flutter faced a lower risk of ischemic stroke than patients with atrial fibrillation.Published by Elsevier Inc.

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