Abstract

Purpose: Atrial fibrillation (AF) is associated with the risk of ischemic stroke, regardless of the administration of appropriate antithrombotic prophylaxis. This study investigated whether influenza vaccination is associated with the risk of ischemic stroke, to determine a solution to reduce this risk in patients with AF. Methods: We used data from the Taiwan National Health Insurance Research Database. The study cohort comprised all patients diagnosed as having AF (n = 14 454) before January 1, 2005; these patients were followed until December 31, 2012. The index date was January 1, 2005. A propensity score was derived using a logistic regression model to estimate the effect of vaccination by accounting for covariates that predict receiving the intervention (vaccine). A Cox proportional hazard model was used to calculate the hazard ratios (HRs) of ischemic stroke in vaccinated and unvaccinated patients with AF. Results: We included 6570 patients (2547 [38.77%] with and 4023 [61.23%] without influenza vaccination). The adjusted HRs (aHRs) of ischemic stroke were lower in the vaccinated patients than in the unvaccinated patients (influenza season, noninfluenza season, and all seasons: aHRs = 0.59, 0.50, and 0.55; P < 0.001, P < 0.001, and P < 0.001, respectively). Conclusions: Influenza vaccination might exert a dose-response effect against ischemic stroke in patients with AF who have risk factors for ischemic stroke by reducing the incidence of ischemic stroke, particularly in those aged 65-74 and ≥75 y.

Original languageEnglish
Pages (from-to)112697-112711
Number of pages15
JournalOncotarget
Volume8
Issue number68
DOIs
Publication statusPublished - Jan 1 2017

Fingerprint

Atrial Fibrillation
Human Influenza
Vaccination
Cohort Studies
Stroke
Population
Logistic Models
Propensity Score
National Health Programs
Taiwan
Proportional Hazards Models
Vaccines
Databases
Incidence
Research

Keywords

  • Atrial fibrillation
  • Influenza vaccination
  • Ischemic stroke

ASJC Scopus subject areas

  • Oncology

Cite this

@article{cb64a190a2614849a8c045bd7028180b,
title = "Influenza vaccination might reduce the risk of ischemic stroke in patients with atrial fibrillation: A population-based cohort study",
abstract = "Purpose: Atrial fibrillation (AF) is associated with the risk of ischemic stroke, regardless of the administration of appropriate antithrombotic prophylaxis. This study investigated whether influenza vaccination is associated with the risk of ischemic stroke, to determine a solution to reduce this risk in patients with AF. Methods: We used data from the Taiwan National Health Insurance Research Database. The study cohort comprised all patients diagnosed as having AF (n = 14 454) before January 1, 2005; these patients were followed until December 31, 2012. The index date was January 1, 2005. A propensity score was derived using a logistic regression model to estimate the effect of vaccination by accounting for covariates that predict receiving the intervention (vaccine). A Cox proportional hazard model was used to calculate the hazard ratios (HRs) of ischemic stroke in vaccinated and unvaccinated patients with AF. Results: We included 6570 patients (2547 [38.77{\%}] with and 4023 [61.23{\%}] without influenza vaccination). The adjusted HRs (aHRs) of ischemic stroke were lower in the vaccinated patients than in the unvaccinated patients (influenza season, noninfluenza season, and all seasons: aHRs = 0.59, 0.50, and 0.55; P < 0.001, P < 0.001, and P < 0.001, respectively). Conclusions: Influenza vaccination might exert a dose-response effect against ischemic stroke in patients with AF who have risk factors for ischemic stroke by reducing the incidence of ischemic stroke, particularly in those aged 65-74 and ≥75 y.",
keywords = "Atrial fibrillation, Influenza vaccination, Ischemic stroke",
author = "Kao, {Pai Feng} and Liu, {Ju Chi} and Hsu, {Yi Ping} and Sung, {Li Chin} and Yang, {Tsung Yeh} and Hao, {Wen Rui} and Lin, {Ying Chin} and Wu, {Szu Yuan}",
year = "2017",
month = "1",
day = "1",
doi = "10.18632/oncotarget.22352",
language = "English",
volume = "8",
pages = "112697--112711",
journal = "Oncotarget",
issn = "1949-2553",
publisher = "Impact Journals LLC",
number = "68",

}

TY - JOUR

T1 - Influenza vaccination might reduce the risk of ischemic stroke in patients with atrial fibrillation

T2 - A population-based cohort study

AU - Kao, Pai Feng

AU - Liu, Ju Chi

AU - Hsu, Yi Ping

AU - Sung, Li Chin

AU - Yang, Tsung Yeh

AU - Hao, Wen Rui

AU - Lin, Ying Chin

AU - Wu, Szu Yuan

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Purpose: Atrial fibrillation (AF) is associated with the risk of ischemic stroke, regardless of the administration of appropriate antithrombotic prophylaxis. This study investigated whether influenza vaccination is associated with the risk of ischemic stroke, to determine a solution to reduce this risk in patients with AF. Methods: We used data from the Taiwan National Health Insurance Research Database. The study cohort comprised all patients diagnosed as having AF (n = 14 454) before January 1, 2005; these patients were followed until December 31, 2012. The index date was January 1, 2005. A propensity score was derived using a logistic regression model to estimate the effect of vaccination by accounting for covariates that predict receiving the intervention (vaccine). A Cox proportional hazard model was used to calculate the hazard ratios (HRs) of ischemic stroke in vaccinated and unvaccinated patients with AF. Results: We included 6570 patients (2547 [38.77%] with and 4023 [61.23%] without influenza vaccination). The adjusted HRs (aHRs) of ischemic stroke were lower in the vaccinated patients than in the unvaccinated patients (influenza season, noninfluenza season, and all seasons: aHRs = 0.59, 0.50, and 0.55; P < 0.001, P < 0.001, and P < 0.001, respectively). Conclusions: Influenza vaccination might exert a dose-response effect against ischemic stroke in patients with AF who have risk factors for ischemic stroke by reducing the incidence of ischemic stroke, particularly in those aged 65-74 and ≥75 y.

AB - Purpose: Atrial fibrillation (AF) is associated with the risk of ischemic stroke, regardless of the administration of appropriate antithrombotic prophylaxis. This study investigated whether influenza vaccination is associated with the risk of ischemic stroke, to determine a solution to reduce this risk in patients with AF. Methods: We used data from the Taiwan National Health Insurance Research Database. The study cohort comprised all patients diagnosed as having AF (n = 14 454) before January 1, 2005; these patients were followed until December 31, 2012. The index date was January 1, 2005. A propensity score was derived using a logistic regression model to estimate the effect of vaccination by accounting for covariates that predict receiving the intervention (vaccine). A Cox proportional hazard model was used to calculate the hazard ratios (HRs) of ischemic stroke in vaccinated and unvaccinated patients with AF. Results: We included 6570 patients (2547 [38.77%] with and 4023 [61.23%] without influenza vaccination). The adjusted HRs (aHRs) of ischemic stroke were lower in the vaccinated patients than in the unvaccinated patients (influenza season, noninfluenza season, and all seasons: aHRs = 0.59, 0.50, and 0.55; P < 0.001, P < 0.001, and P < 0.001, respectively). Conclusions: Influenza vaccination might exert a dose-response effect against ischemic stroke in patients with AF who have risk factors for ischemic stroke by reducing the incidence of ischemic stroke, particularly in those aged 65-74 and ≥75 y.

KW - Atrial fibrillation

KW - Influenza vaccination

KW - Ischemic stroke

UR - http://www.scopus.com/inward/record.url?scp=85038840927&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85038840927&partnerID=8YFLogxK

U2 - 10.18632/oncotarget.22352

DO - 10.18632/oncotarget.22352

M3 - Article

VL - 8

SP - 112697

EP - 112711

JO - Oncotarget

JF - Oncotarget

SN - 1949-2553

IS - 68

ER -