Self-reported risk of stroke and factors associated with underestimation of stroke risk among older adults with atrial fibrillation: the SAGE-AF study  

作　　者：Jordy Mehawej Jane Saczynski Jerry H.Gurwitz Hawa O.Abu Benita A.Bamgbade Wei-Jia WANG Tenes Paul Katherine Trymbulak Connor Saleeba Zi-Yue WANG Catarina I.Kiefe Robert J.Goldberg David D.Mc Manus 

机构地区：[1]Division of Cardiovascular Medicine,Department of Medicine,University of Massachusetts Medical School,Worcester,MA,USA [2]Department of Pharmacy and Health Systems Sciences,School of Pharmacy,Northeastern University,Boston,MA,USA [3]Department of Population and Quantitative Health Sciences,University of Massachusetts Medical School,Worcester,MA,USA [4]Division of Geriatric Medicine and Meyers Primary Care Institute,University of Massachusetts Medical School,Worcester,MA,USA

出　　处：《Journal of Geriatric Cardiology》2020年第8期502-509,共8页老年心脏病学杂志（英文版）

基　　金：supported by the National Heart,Lung,and Blood Institute(R01HL126911);supported by the NIH Training Grant entitled Transdisciplinary Training in Cardiovascular Research 5T32HL120823-05;supported by the National Heart,Lung,and Blood Institute(R01HL137734&R01HL 137794&R01HL13660&R01HL141434&U54HL143541)。

摘　　要：Background Though engaging patients with atrial fibrillation(AF) in understanding their stroke risk is encouraged by guidelines, little is known regarding AF patients' perceived stroke risk or its relationship with oral anticoagulation(OAC) use. We aim to identify factors associated with underestimation of stroke risk among older patients with AF and relate this to OAC use. Methods Data are from the ongoing SAGE(Systematic Assessment of Geriatric Elements)-AF study, which included older patients(> 65 years) with non-valvular AF and a CHA2 DS2-VASc score of ≥ 2. Participants reported their perceived risk of having a stroke without OAC. We compared the perceived risk to CHA2 DS2-VASc predicted stroke risk and classified participants as "over" or "under" estimators, and identified factors associated with underestimation of risk using multiple logistic regression. Results The average CHA2 DS2-VASc score of 915 participants(average age: 75 years, 47% female, 86% white) was 4.3 ± 1.6, 43% of participants had discordant predicted and self-reported stroke risks. Among the 376 participants at highest risk(CHA2 DS2-VASc score ≥ 5), 46% of participants underestimated their risk. Older participants(≥ 85 years) were more likely and OAC treated patients less likely to underestimate their risk of developing a future stroke than respective comparison groups. Conclusions A significant proportion of study participants misperceived their stroke risk, mostly by overestimating. Almost half of participants at high risk of stroke underestimated their risk, with older patients more likely to do so. Patients on OAC were less likely to underestimate their risk, suggesting that successful efforts to educate patients about their stroke risk may influence treatment choices.

关 键 词：ANTICOAGULATION Atrial fibrillation STROKE 

分 类 号：R541.75[医药卫生—心血管疾病]