Evidence map›Paper›PMID 27515684›Full record

ArticleLancet (London, England)2016

Occurrence of death and stroke in patients in 47 countries 1 year after presenting with atrial fibrillation: a cohort study.

Jeff S Healey, Jonas Oldgren, Michael Ezekowitz, Jun Zhu, Prem Pais, Jia Wang, Patrick Commerford, Petr Jansky, Alvaro Avezum, Alben Sigamani and 11 more

Erratum issued Registry-linked trialAbstract read
PubMed Publisher
In one paragraph

Article in Lancet (London, England), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT02211326 (Pharmacogenetic Algorithm of Response to Warfarin During Initial Anticoagulation in Chinese Elderly Patients), which is not on this map. Cited by 144 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
144citing papers in PubMed, 9 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02211326 nacompletednot on this map

Pharmacogenetic Algorithm of Response to Warfarin During Initial Anticoagulation in Chinese Elderly Patients

TypeinterventionalSponsorThe Third Xiangya Hospital of Central South UniversityRan2014 to 2017Enrolled660ConditionsAtrial Fibrillation, Deep Venous ThrombosisArmsGenotype-guided dosing algorithm for warfarin, Standard initiation dose for warfarin
3 · Its place in the literature

Who cites it

144 citing papers in PubMed, 9 syntheses or guidelines pooled it.

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  17. Impact of anemia prior to catheter ablation for atrial fibrillation on clinical outcomes: a U.S. retrospective cohort analysis.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026
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84 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

21 authors.

Jeff S HealeyPopulation Health Research Institute, McMaster University, Hamilton, ON, Canada. Electronic address: Jeff.Healey@phri.ca.
Jonas OldgrenUppsala Clinical Research, Uppsala, Sweden.
Michael EzekowitzLankenau Institute for Medical Research, Wynnewood, PA, USA.
Jun ZhuFuwai Hospital CAMS and PUMC, Beijing, China.
Prem PaisSt John's Medical College and Bangalore Research Institute, Bangalore, India.
Jia WangPopulation Health Research Institute, McMaster University, Hamilton, ON, Canada.
Patrick CommerfordDepartment of Medicine, University of Cape Town, Cape Town, South Africa.
Petr JanskyUniversity Hospital Motol, Prague, Czech Republic.
Alvaro AvezumInstituto Dante Pazzanesse de Cardiologia, Sao Paulo, Brazil.
Alben SigamaniSt John's Medical College and Bangalore Research Institute, Bangalore, India.
Albertino DamascenoEduardo Mondlane University, Maputo, Mozambique.
Paul ReillyBoehringer Ingelheim, Bieberach, Germany.
Alex GrinvaldsPopulation Health Research Institute, McMaster University, Hamilton, ON, Canada.
Juliet NakamyaPopulation Health Research Institute, McMaster University, Hamilton, ON, Canada.
Akinyemi AjeUniversity College Hospital, Ibadan, Nigeria.
Wael AlmahmeedSheikh Khalifa Medical City and Cleveland Clinic, Abu Dhabi, United Arab Emirates.
Andrew MoriartyCraigavon Area Hospital, Craigavon, County Armagh, UK.
Lars WallentinUppsala Clinical Research, Uppsala, Sweden.
Salim YusufPopulation Health Research Institute, McMaster University, Hamilton, ON, Canada.
Stuart J ConnollyPopulation Health Research Institute, McMaster University, Hamilton, ON, Canada.
RE-LY Atrial Fibrillation Registry and Cohort Study Investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAtrial fibrillation is an important cause of morbidity and mortality worldwide, but scant data are available for long-term outcomes in individuals outside North America or Europe, especially in primary care settings.

methodsWe did a cohort study using a prospective registry of patients in 47 countries who presented to a hospital emergency department with atrial fibrillation or atrial flutter as a primary or secondary diagnosis. 15 400 individuals were enrolled to determine the occurrence of death and strokes (the primary outcomes) in this cohort over eight geographical regions (North America, western Europe, and Australia; South America; eastern Europe; the Middle East and Mediterranean crescent; sub-Saharan Africa; India; China; and southeast Asia) 1 year after attending the emergency department. Patients from North America, western Europe, and Australia were used as the reference population, and compared with patients from the other seven regions

findingsBetween Dec 24, 2007, and Oct 21, 2011, we enrolled 15 400 individuals to the registry. Follow-up was complete for 15 361 (99·7%), of whom 1758 (11%) died within 1 year. Fewer deaths occurred among patients presenting to the emergency department with a primary diagnosis of atrial fibrillation compared with patients who had atrial fibrillation as a secondary diagnosis (377 [6%] of 6825 patients vs 1381 [16%] of 8536, p<0·0001). Twice as many patients had died by 1 year in South America (192 [17%] of 1132) and Africa (225 [20%] of 1137) compared with North America, western Europe, and Australia (366 [10%] of 3800, p<0·0001). Heart failure was the most common cause of death (519 [30%] of 1758); stroke caused 148 (8%) deaths. 604 (4%) of 15361 patients had had a stroke by 1 year; 170 (3%) of 6825 for whom atrial fibrillation was a primary diagnosis and 434 (5%) of 8536 for whom it was a secondary diagnosis (p<0·0001). The highest number of strokes occurred in patients in Africa (89 [8%] of 1137), China (143 [7%] of 2023), and southeast Asia (88 [7%] of 1331) and the lowest occurred in India (20 [<1%] of 2536). 94 (3%) of 3800 patients in North America, western Europe, and Australia had a stroke.

interpretationMarked unexplained inter-regional variations in the occurrence of stroke and mortality suggest that factors other than clinical variables might be important. Prevention of death from heart failure should be a major priority in the treatment of atrial fibrillation.

fundingBoehringer Ingelheim.

Indexed as

DeathAdultAgedAtrial FibrillationCohort StudiesComorbidityFemaleGlobal HealthHumansIncidenceMaleMiddle AgedStroke

Identifiers

PMID27515684

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