Article Text

Download PDFPDF
Research paper
Age-specific trends of atrial fibrillation-related ischaemic stroke and transient ischaemic attack, anticoagulant use and risk factor profile in Chinese population: a 15-year study
  1. Yannie Soo,
  2. Nathan Chan,
  3. Kam Tat Leung,
  4. Xiang-Yan Chen,
  5. Vincent Mok,
  6. Lawrence Wong,
  7. Thomas Leung
  1. Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
  1. Correspondence to Professor Thomas Leung, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, 9/F Lui Chi Woo Clinical Science Building, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong; drtleung{at}


Background Prevalence of atrial fibrillation (AF) is increasing globally, and the fivefold increase in stroke risk constitutes significant healthcare burden.

Aims We aim to evaluate the trends of AF-related stroke and transient ischaemic attack (AF-stroke/TIA), prior anticoagulant use and their risk factors in different age groups in Chinese population.

Methods Data were retrieved from the stroke registry at Prince of Wales Hospital. We compared the data at 5-year intervals over a 15-year period (years 1999, 2004, 2009 and 2014).

Results A total of 3894 patients were included, 712 patients had AF-stroke/TIA. Over the 15 years, the total number of ischaemic stroke/TIA fluctuated slightly during the period from year 1999 to 2009, and increased by 21.5% in the year 2014. While AF-stroke/TIA increased continuously with time by 282.1%. Increasing trend of AF-stroke/TIA was observed in all age groups. Absolute growth was highest in patients aged ≥80 years; relative growth was most pronounced in those between 65 and 72 years (>3.5 fold increase). Throughout the 15 years, >70% of AF-stroke/TIA occurred in non-anticoagulated patients, and this proportion increased with age. Increasing trends in both hypertension and ischaemic heart disease were also observed in patients with AF aged ≥73 years.

Conclusion AF-stroke/TIA has increased continuously by >2.5 fold in Chinese population over a 15-year period, with the majority of AF-stroke/TIA occurring in non-anticoagulated patients. Strategic planning is needed to optimise anticoagulant use, particularly non-vitamin K antagonist oral anticoagulants in elderly patients, low-income group and those with ischaemic heart disease requiring concomitant antiplatelet therapy.

  • Trends
  • age
  • atrial fibrillation
  • stroke
  • anticoagulant.
View Full Text

Statistics from


  • Contributors YS conceptualised the project, wrote protocol, performed literature review, collected and analysed data and drafted manuscript. NC and XYC collected and analysed data. KTL designed data extraction form, collected data and performed all statistical analyses. VM interpreted data and reviewed manuscript. LW and TL conceptualised project, reviewed protocol and manuscript.

  • Funding This study was supported by Kwok Tak Seng Centre for Stroke Research and Intervention.

  • Competing interests None declared.

  • Ethics approval Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice Since this paper was first published online labels A-D have been added to figure 2. In table 2 symbols have been added to the data.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.