NEUROLOGY 1978;28:973
© 1978 American Academy of Neurology
Epidemiologic assessment of chronic atrial fibrillation and risk of stroke
The fiamingham Study
Philip A. Wolf, M.D,
Thomas R. Dawber, M.D., M.P.H.,
H. Emerson Thomas, Jr., M.D. and
William B. Kannel, M.D., M.P.H.
Department of Neurology (Dr. Wolf); and the Section on Preventive Medicine of the Division of Medicine (Drs. Dawber and Thomas), Boston University School of Medicine, Boston, Massachusetts; and the Heart Disease Epidemiology Study (Dr. Kannel), National Heart and Lung Institute, Framingham, Massachusetts.
Chronic atrial fibrillation (AF) as a precursor of stroke was assessed over 24 years of follow-up of the general population sample at Framingham, Massachusetts. Persons with chronic established AF, with or without rheumatic heart disease (RHD), are at greatly increased risk of stroke, and the stroke is probably due to embolism. Chronic AF in the absence of RHD is associated with more than a fivefold increase in stroke incidence, while AF with RHD has a 17-fold increase. Stroke occurrence increased as duration of AF increased, with no evidence of a particularly vulnerable period. Chronic idiopathic AF is an important precursor of cerebral embolism. Controlled trials of anticoagulants or antiarrhythmic agents in persons with chronic AF may demonstrate if strokes can be prevented in this highly susceptible group.
Reprint requests should be addressed to Dr. Wolf, Department of Neurology, Boston University School of Medicine, 80 East Concord Street, Boston, MA 02118.
Presented in part at the twenty-eighth annual meeting of the American Academy of Neurology, April 29, 1976, Toronto, Canada.
Supported in part by Research Grant NS 09695-05 from the National Institutes of Health.
Accepted for publication September 12, 1977.
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Guidelines for the management of patients with atrial fibrillation. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology
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