Association Between Dehydration and Short-Term Risk of Ischemic Stroke in Patients with Atrial Fibrillation
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ORIGINAL ARTICLE
Association Between Dehydration and Short-Term Risk of Ischemic Stroke in Patients with Atrial Fibrillation Joel N. Swerdel 1,2 & Teresa M. Janevic 2 & William J. Kostis 3 & Ambarina Faiz 4 & Nora M. Cosgrove 1 & John B. Kostis 1 & The Myocardial Infarction Data Acquisition System (MIDAS 27) Study Group
Received: 15 December 2015 / Revised: 10 May 2016 / Accepted: 13 May 2016 # Springer Science+Business Media New York 2016
Abstract Previous cross-sectional studies have demonstrated a higher incidence of dehydration in patients admitted for stroke suggesting a possible association. However, the temporality of the association has not been well established. We examined whether dehydration increases the risk of ischemic stroke in patients with a recent hospitalization for atrial fibrillation (AF). Data was from 1994 to 2012 from the Myocardial Infarction Data Acquisition System (MIDAS), a repository of in-patient records New Jersey hospitals, for AF hospitalizations (n = 1,282,787). Estimates for the association between AF hospitalization with/without dehydration and ischemic stroke within 30 days post-AF discharge were determined using log-linear multivariable modeling adjusting for socio-demographic factors and comorbid conditions. Within 10 days of discharge for AF, patients 18–80 years old (YO) with comorbid dehydration had a 60 % higher risk of ischemic stroke
* Joel N. Swerdel [email protected]
1
The Cardiovascular Institute at Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, Suite 5200, New Brunswick, NJ 08901, USA
2
Department of Epidemiology, Rutgers University School of Public Health, Piscataway, NJ 08854, USA
3
Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
4
Division of Hematology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
compared to AF patients without comorbid dehydration (adjusted risk ratio (ARR) 1.60, 95 % confidence interval (CI) 1.28–2.00). Eighteen- to 80-YO patients had a 34 % higher risk of ischemic stroke in days 11–20 postAF discharge (ARR 1.34, 95 % CI 1.04, 1.74). There was no difference in the risk of stroke in 18–80-YO patients with or without prior dehydration during days 21–30 post-AF discharge. We also found no difference in the risk of ischemic stroke during any time period in patients over 80 YO. Dehydration may be a significant risk factor for ischemic stroke in patients 18–80 YO with AF. Keywords Ischemic stroke . Hemorrhagic stroke . Myocardial infarction . Dehydration . Cardiovascular
Introduction Many studies have found an association between dehydration and stroke. However, the temporal sequence of the association and the underlying mechanisms are in question. Studies to date have primarily focused on the incidence of comorbid dehydration in patients admitted for ischemic stroke [1–3]. From these studies, it is not possible to determine whether ischemic stroke preceded dehydration or vice versa. Current American Heart
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