Accepted Manuscript The Association between Red Cell Distribution Width and Stroke in Patients with Atrial Fibrillation Walid Saliba, M.D., MPH Ofra Barnett-Griness, Ph.D Mazen Elias, M.D. Gad Rennert, M.D., Ph.D. PII:
S0002-9343(14)00895-X
DOI:
10.1016/j.amjmed.2014.09.020
Reference:
AJM 12706
To appear in:
The American Journal of Medicine
Received Date: 21 August 2014 Revised Date:
23 September 2014
Accepted Date: 23 September 2014
Please cite this article as: Saliba W, Barnett-Griness O, Elias M, Rennert G, The Association between Red Cell Distribution Width and Stroke in Patients with Atrial Fibrillation, The American Journal of Medicine (2014), doi: 10.1016/j.amjmed.2014.09.020. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
-1-
ACCEPTED MANUSCRIPT The Association between Red Cell Distribution Width and Stroke in Patients with Atrial Fibrillation Walid Saliba, M.D., MPH1,2, Ofra Barnett-Griness, Ph.D1, Mazen Elias, M.D.2,
RI PT
Gad Rennert, M.D., Ph.D.1,3 1. Department of Community Medicine and Epidemiology, Carmel Medical
Center, Clalit Health Services, and Bruce Rappaport Faculty of Medicine,
SC
Technion–Israel Institute of Technology, Haifa, Israel
2. Internal Medicine C, Ha'emek Medical Center, Afula, Israel.
M AN U
3. Department of Epidemiology and Disease Prevention, Office of the Chief Physician, Clalit Health Services Headquarters, Tel Aviv, Israel. Article type: Clinical Research Study Word count: 2774
TE D
Funding source: There was no funding source for the preparation of this manuscript Conflict of interest statement: All authors declare that there is no conflict of interest All authors declare that they had access to the data and took part in the writing
EP
of this manuscript.
Running head: Red cell distribution width and stroke prediction in atrial fibrillation
AC C
Key words: Atrial fibrillation; CHADS2; CHA2DS2-VASc; Red cell distribution width; Stroke
Address of corresponding author: Walid Saliba, M.D., MPH Department of Internal Medicine C, Ha'emek Medical Center, 18101 Afula, Israel Tel: 972-4-6495132 Fax:972-4-6495243 e-mail: [email protected]
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ACCEPTED MANUSCRIPT Abstract Background: Red cell distribution width is associated with increased risk of cardiovascular morbidity and mortality. We aimed to assess its association with stroke in patients with atrial fibrillation.
RI PT
Methods: Using the computerized database of the largest HMO in Israel we identified a cohort of adults with atrial fibrillation diagnosed before January 1st 2012. Eligible
subjects were not on anticoagulants at baseline, and had at least one blood cell count
SC
performed in 2011 (41,140 subjects). The cohort was followed for the first occurrence of stroke until December 31st 2012.
M AN U
Results: Overall 1,692 subjects developed stroke during 38,024 person-years follow up, (stroke rate, 4.45 per 100 person-years). Stroke incidence rate increased across red cell distribution width quartiles; 3.26, 3.71, 5.01, and 6.05 per 100 person-years, respectively. On multivariate analysis adjusting for CHADS2 score risk factors, the
TE D
HR for stroke was 1.29 (95% CI, 1.17-1.42) in subjects with red cell distribution width >14.5% compared to those with values ≤14.5%, and was similar in subjects with and without anemia. When analyzed as quartiles, the HR for stroke was 1.33
EP
(1.15-1.53) in the highest quartile compared to the lowest quartile, and was similar in
AC C
subjects with and without anemia. The area under the receiver operating characteristic curve was 0.598 for CHADS2 score, and increased to 0.618 when red cell distribution width was included in the model (P 14.5%. Anemia was defined as hemoglobin levels
S0002-9343(14)00895-X
DOI:
10.1016/j.amjmed.2014.09.020
Reference:
AJM 12706
To appear in:
The American Journal of Medicine
Received Date: 21 August 2014 Revised Date:
23 September 2014
Accepted Date: 23 September 2014
Please cite this article as: Saliba W, Barnett-Griness O, Elias M, Rennert G, The Association between Red Cell Distribution Width and Stroke in Patients with Atrial Fibrillation, The American Journal of Medicine (2014), doi: 10.1016/j.amjmed.2014.09.020. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
-1-
ACCEPTED MANUSCRIPT The Association between Red Cell Distribution Width and Stroke in Patients with Atrial Fibrillation Walid Saliba, M.D., MPH1,2, Ofra Barnett-Griness, Ph.D1, Mazen Elias, M.D.2,
RI PT
Gad Rennert, M.D., Ph.D.1,3 1. Department of Community Medicine and Epidemiology, Carmel Medical
Center, Clalit Health Services, and Bruce Rappaport Faculty of Medicine,
SC
Technion–Israel Institute of Technology, Haifa, Israel
2. Internal Medicine C, Ha'emek Medical Center, Afula, Israel.
M AN U
3. Department of Epidemiology and Disease Prevention, Office of the Chief Physician, Clalit Health Services Headquarters, Tel Aviv, Israel. Article type: Clinical Research Study Word count: 2774
TE D
Funding source: There was no funding source for the preparation of this manuscript Conflict of interest statement: All authors declare that there is no conflict of interest All authors declare that they had access to the data and took part in the writing
EP
of this manuscript.
Running head: Red cell distribution width and stroke prediction in atrial fibrillation
AC C
Key words: Atrial fibrillation; CHADS2; CHA2DS2-VASc; Red cell distribution width; Stroke
Address of corresponding author: Walid Saliba, M.D., MPH Department of Internal Medicine C, Ha'emek Medical Center, 18101 Afula, Israel Tel: 972-4-6495132 Fax:972-4-6495243 e-mail: [email protected]
-2-
ACCEPTED MANUSCRIPT Abstract Background: Red cell distribution width is associated with increased risk of cardiovascular morbidity and mortality. We aimed to assess its association with stroke in patients with atrial fibrillation.
RI PT
Methods: Using the computerized database of the largest HMO in Israel we identified a cohort of adults with atrial fibrillation diagnosed before January 1st 2012. Eligible
subjects were not on anticoagulants at baseline, and had at least one blood cell count
SC
performed in 2011 (41,140 subjects). The cohort was followed for the first occurrence of stroke until December 31st 2012.
M AN U
Results: Overall 1,692 subjects developed stroke during 38,024 person-years follow up, (stroke rate, 4.45 per 100 person-years). Stroke incidence rate increased across red cell distribution width quartiles; 3.26, 3.71, 5.01, and 6.05 per 100 person-years, respectively. On multivariate analysis adjusting for CHADS2 score risk factors, the
TE D
HR for stroke was 1.29 (95% CI, 1.17-1.42) in subjects with red cell distribution width >14.5% compared to those with values ≤14.5%, and was similar in subjects with and without anemia. When analyzed as quartiles, the HR for stroke was 1.33
EP
(1.15-1.53) in the highest quartile compared to the lowest quartile, and was similar in
AC C
subjects with and without anemia. The area under the receiver operating characteristic curve was 0.598 for CHADS2 score, and increased to 0.618 when red cell distribution width was included in the model (P 14.5%. Anemia was defined as hemoglobin levels
