Stroke and death in elderly patients with atrial fibrillation in Japan compared to the United Kingdom

Research output: Contribution to journalArticlepeer-review


  • Keitaro Senoo
  • Yoshimori An
  • Hisashi Ogawa
  • Andreas Wolff
  • Eduard Shantsila
  • Masaharu Akao

Colleges, School and Institutes


Data on stroke, mortality and associated comorbidities in elderly atrial fibrillation (AF) patients in Japan may differ from Western countries. There has never been a systematic comparison between stroke risk profiles and outcomes amongst community-based elderly patients with AF in Japan and the United Kingdom (UK). Objective and Methods: We compared clinical characteristics, stroke risk and outcomes amongst elderly AF patients from the Fushimi AF Registry (Japan; N=1791) and the Darlington AF registry (UK; N=1338). Results: The Fushimi cohort had a mean age 81.8 years and CHA2DS2- VASc score 4.3(1.4), whereas the Darlington cohort had a mean age 83.6(5.7) years and CHA2DS2-VASc score 4.4(1.4). Over a 12 month follow-up period, observed stroke and mortality rates in Fushimi were 3.4%(n=61) and 11.5%(n=206), whilst corresponding event rates in the Darlington cohort were 4.4%(n=59) and 14.1%(n=188), respectively. Appropriate use of oral anticoagulation (OAC, essentially vitamin K antagonist) was <60% in both registries. On multivariable analysis, ethnicity (Japan vs.UK) was neither associated with the risk of stroke (Odds Ratio[OR] 0.92, 95%CI 0.63-1.36; p=0.69) nor death(OR 0.92, 95%CI 0.80-1.27; p=0.92). In a subgroup analysis of elderly patients not receiving OAC(n=1489), a prior history of stroke was associated with the risk of stroke(OR 2.42; 95%CI 1.39–4.12; p=0.002), but not ethnicity(OR 0.86; 95%CI 0.50-1.47; p=0.58). Conclusions: Elderly(age≥75) AF patients in both Japan and the UK are at similarly high risk of stroke and death, with OAC still under-utilised in both populations. Ethnicity was not independently associated with the risk of stroke, regardless of OAC use or non-use.


Original languageEnglish
Early online date16 Jun 2016
Publication statusE-pub ahead of print - 16 Jun 2016


  • Atrial fibrillation, Cardiac arrhythmias and resuscitation science, diseases, Stroke, Cardiac risk factors and prevention, diseases, Epidemiology, research approaches