London, United Kingdom 2013 8 Epidemiology of stroke 15:40 - 15:50 Incidence, outcome and future projections of atrial fibrillation-related stroke and systemic embolism at age >/=80 years: 10-year results of the Oxford Vascular Study G.S.C. Yiin1, D.P.J. Howard2, N.L.M. Paul3, Z. Mehta4, P.M. Rothwell5 Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, Univer-sity of Oxford, Oxford, UNITED KINGDOM1,Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UNITED KINGDOM2, Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UNITED KINGDOM3, Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UNITED KINGDOM4, Stroke Preven-tion Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Ox-ford, 5 Background: Prevalence of atrial fibrillation (AF) is increasing and now affects over 10% of individuals aged ≥80 years. Warfarin is effective in preventing thromboembolic events, but is substantially under-used in the elderly, and use of new anticoagulants at age ≥80 years is also limited. We determined the incidence and outcome of AF-related thromboembolic events at all ages in a population-based study and projected future event rates. Methods: We studied age-specific incidence and outcome of all AF-related incident strokes and systemic emboli from 2002-2012 in the Oxford Vascular Study (OXVASC) in relation to premorbid use of warfarin. Future projections for incidence of AF-related strokes and systemic emboli were made based on predicted changes in population age and sex. Results: Among 3096 TIA, stroke or acute peripheral vascular events, there were 748 (24.2%) AF-related events, including 383 incident ischaemic strokes and 71 incident systemic emboli. Incidence increased steeply with age, with 272 (59•9%) events occurring at ≥80 years. Of 208 patients with incident events at age ≥80 years and known prior AF, 189 (90•9%) were not on warfarin. Among these cases, the premor-bid CHADS2 score was ≥2 in 167 (88•4%), there was no documented contraindication to war-farin in 144 (76•2%), and of 99 patients who were independent prior to their event, 73 (73•7%) were dead or disabled at six months follow-up. Extrapolated to the UK population aged ≥80 years, 19,012 AF-related ischaemic strokes and 4189 systemic emboli would have been expect-ed in 2010, increasing to 60,528 and 14,968 respectively by 2050, by which time 84% of all AF-related thromboembolic events will occur at age ≥80 years and 42.1% at ≥90 years. Con-clusion: Numbers of AF-related ischaemic strokes at age ≥80 years are projected to treble by 2050, along with numbers of systemic emboli, unless rates of anticoagulation in older patients increase. Cerebrovasc Dis 2013; 35 (suppl 3)1-854 143 7 Epidemiology of stroke 15:30 - 15:40 16-year time trends in incidence of pathological and aetiological stroke subtypes: the Erlangen Stroke Project P.L. Kolominsky-Rabas1, S. Wiedmann2, M. Weingärtner3, M. Buchfelder4, S. Schwab5, P.U. Heuschmann6 University Hospital Erlangen, Erlangen, GERMANY1,University of Würzburg, Würzburg, GERMANY2, University Hospital Erlangen, Erlangen, GERMANY3, University Hospital Er-langen, Erlangen, GERMANY4, University Hospital Erlangen, Erlangen, 5, University of Würz-burg, Würzburg, GERMANY6 Background: Population-based data continuously monitoring time trends in stroke epidemiolo-gy are scarce. We investigated incidence of pathological and aetiological stroke subtypes over a sixteen-year time period. Methods: Changes in stroke incidence were investigated within the Erlanger Stroke Project (ESPro). The ESPro is a prospective, population-based stroke register in the city of Erlangen, Bavaria, Germany, covering a total study population of 105 164 inhabitants (census 2010) ap-plying standardized methods for ensuring completeness of case ascertainment. Aetiology of ischemic stroke was classified according to the “The Trial of ORG 10172 in Acute Stroke Treat-ment” (TOAST) criteria. Total and stroke subtype specific incidence rates were age adjusted to the European population. Findings: Between Jan 1995 and Dec 2010, 3243 patients with first-ever stroke were registered. Median age was 75 years (Inter-Quartile-Range 66-82), 1787 (55.2%) were females. The pro-portion of pathological stroke subtypes was as follows: ischemic stroke (IS) 79.7%; primary intracerebral haemorrhage 12.2%; subarachnoidal haemorrhage 3.0%; unspecified stroke 5.1%. Total stroke incidence decreased over the sixteen-year study period in men (Incidence Rate Ra-tio 1995-1996 versus 2009-2010 (IRR) 0.72; 95% CI 0.58-0.90) but not in women (IRR 0.90; 95% CI 0.74-1.10). Among pathological stroke subtypes a decrease in IS incidence was found in men (IRR 0.73; 95% CI 0.57-0.93). Incidence of large artery atherosclerotic (LAA) stroke decreased in men (IRR 0.27, 95%CI 0.12-0.59) and of small artery occlusion (SAO) increased in women (IRR 2.33; 95% CI 1.39-3.90). Summary: In our study substantial variation in time trends of major aetiological stroke subtypes were seen between men and women, which might be linked to gender differences in develop-ment of major vascular risk factors in our local population.
Karger_ESC London_2013
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