Abstract

Purpose The risk of hemorrhagic stroke in patients with atrial fibrillation (AF) is low but the consequences of its occurrence are extremely severe. In this study, we investigated the association of influenza vaccination with the risk of hemorrhagic stroke to develop an efficient strategy for reducing this risk in patients with AF. Methods In this study, data were retrieved from the Taiwan National Health Insurance Research Database. The study cohort comprised all patients who received a diagnosis of AF (n = 14,454) before January 1, 2005 (index date) and were followed until December 31, 2012. Propensity scores were calculated using a logistic regression model to determine the effects of vaccination by accounting for covariates that predict receiving the intervention (vaccine). A time-dependent Cox proportional hazard model was used to calculate the hazard ratios (HRs) for hemorrhagic stroke in vaccinated and unvaccinated patients with AF. Results The study population comprised 6570 patients who did (2547 [38.77%]) and did not receive (4023 [61.23%]) influenza vaccination. The adjusted HRs (aHRs) for hemorrhagic stroke were lower in the vaccinated patients than in the unvaccinated patients (influenza season, noninfluenza season, and all seasons: aHRs = 0.97 [0.59–1.60], 0.51 [0.30–0.87], and 0.72 [0.50–1.03], respectively). Conclusions Influenza vaccination exerts dose–response and synergistic protective effects against hemorrhagic stroke in patients with AF who have a high risk of hemorrhagic stroke (i.e., male sex, age ≥ 75 years, Charlson comorbidity index ≥ 3, and hypertension) and reduces the incidence of hemorrhagic stroke.

Original languageEnglish
Pages (from-to)315-323
Number of pages9
JournalInternational Journal of Cardiology
Volume232
DOIs
Publication statusPublished - Apr 1 2017

Fingerprint

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

Keywords

  • Atrial fibrillation
  • Hemorrhagic stroke
  • Influenza vaccination

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

@article{16f34faf75e845cd9c1837d9bd12720a,
title = "Influenza vaccination reduces hemorrhagic stroke risk in patients with atrial fibrillation: A population-based cohort study",
abstract = "Purpose The risk of hemorrhagic stroke in patients with atrial fibrillation (AF) is low but the consequences of its occurrence are extremely severe. In this study, we investigated the association of influenza vaccination with the risk of hemorrhagic stroke to develop an efficient strategy for reducing this risk in patients with AF. Methods In this study, data were retrieved from the Taiwan National Health Insurance Research Database. The study cohort comprised all patients who received a diagnosis of AF (n = 14,454) before January 1, 2005 (index date) and were followed until December 31, 2012. Propensity scores were calculated using a logistic regression model to determine the effects of vaccination by accounting for covariates that predict receiving the intervention (vaccine). A time-dependent Cox proportional hazard model was used to calculate the hazard ratios (HRs) for hemorrhagic stroke in vaccinated and unvaccinated patients with AF. Results The study population comprised 6570 patients who did (2547 [38.77{\%}]) and did not receive (4023 [61.23{\%}]) influenza vaccination. The adjusted HRs (aHRs) for hemorrhagic stroke were lower in the vaccinated patients than in the unvaccinated patients (influenza season, noninfluenza season, and all seasons: aHRs = 0.97 [0.59–1.60], 0.51 [0.30–0.87], and 0.72 [0.50–1.03], respectively). Conclusions Influenza vaccination exerts dose–response and synergistic protective effects against hemorrhagic stroke in patients with AF who have a high risk of hemorrhagic stroke (i.e., male sex, age ≥ 75 years, Charlson comorbidity index ≥ 3, and hypertension) and reduces the incidence of hemorrhagic stroke.",
keywords = "Atrial fibrillation, Hemorrhagic stroke, Influenza vaccination",
author = "Liu, {Ju Chi} and Wang, {Ta Jung} and Li-Chin Sung and Kao, {Pai Feng} and Yang, {Tsung Yeh} and Hao, {Wen Rui} and Chen, {Chun Chao} and Hsu, {Yi Ping} and Wu, {Szu Yuan}",
year = "2017",
month = "4",
day = "1",
doi = "10.1016/j.ijcard.2016.12.074",
language = "English",
volume = "232",
pages = "315--323",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Influenza vaccination reduces hemorrhagic stroke risk in patients with atrial fibrillation

T2 - A population-based cohort study

AU - Liu, Ju Chi

AU - Wang, Ta Jung

AU - Sung, Li-Chin

AU - Kao, Pai Feng

AU - Yang, Tsung Yeh

AU - Hao, Wen Rui

AU - Chen, Chun Chao

AU - Hsu, Yi Ping

AU - Wu, Szu Yuan

PY - 2017/4/1

Y1 - 2017/4/1

N2 - Purpose The risk of hemorrhagic stroke in patients with atrial fibrillation (AF) is low but the consequences of its occurrence are extremely severe. In this study, we investigated the association of influenza vaccination with the risk of hemorrhagic stroke to develop an efficient strategy for reducing this risk in patients with AF. Methods In this study, data were retrieved from the Taiwan National Health Insurance Research Database. The study cohort comprised all patients who received a diagnosis of AF (n = 14,454) before January 1, 2005 (index date) and were followed until December 31, 2012. Propensity scores were calculated using a logistic regression model to determine the effects of vaccination by accounting for covariates that predict receiving the intervention (vaccine). A time-dependent Cox proportional hazard model was used to calculate the hazard ratios (HRs) for hemorrhagic stroke in vaccinated and unvaccinated patients with AF. Results The study population comprised 6570 patients who did (2547 [38.77%]) and did not receive (4023 [61.23%]) influenza vaccination. The adjusted HRs (aHRs) for hemorrhagic stroke were lower in the vaccinated patients than in the unvaccinated patients (influenza season, noninfluenza season, and all seasons: aHRs = 0.97 [0.59–1.60], 0.51 [0.30–0.87], and 0.72 [0.50–1.03], respectively). Conclusions Influenza vaccination exerts dose–response and synergistic protective effects against hemorrhagic stroke in patients with AF who have a high risk of hemorrhagic stroke (i.e., male sex, age ≥ 75 years, Charlson comorbidity index ≥ 3, and hypertension) and reduces the incidence of hemorrhagic stroke.

AB - Purpose The risk of hemorrhagic stroke in patients with atrial fibrillation (AF) is low but the consequences of its occurrence are extremely severe. In this study, we investigated the association of influenza vaccination with the risk of hemorrhagic stroke to develop an efficient strategy for reducing this risk in patients with AF. Methods In this study, data were retrieved from the Taiwan National Health Insurance Research Database. The study cohort comprised all patients who received a diagnosis of AF (n = 14,454) before January 1, 2005 (index date) and were followed until December 31, 2012. Propensity scores were calculated using a logistic regression model to determine the effects of vaccination by accounting for covariates that predict receiving the intervention (vaccine). A time-dependent Cox proportional hazard model was used to calculate the hazard ratios (HRs) for hemorrhagic stroke in vaccinated and unvaccinated patients with AF. Results The study population comprised 6570 patients who did (2547 [38.77%]) and did not receive (4023 [61.23%]) influenza vaccination. The adjusted HRs (aHRs) for hemorrhagic stroke were lower in the vaccinated patients than in the unvaccinated patients (influenza season, noninfluenza season, and all seasons: aHRs = 0.97 [0.59–1.60], 0.51 [0.30–0.87], and 0.72 [0.50–1.03], respectively). Conclusions Influenza vaccination exerts dose–response and synergistic protective effects against hemorrhagic stroke in patients with AF who have a high risk of hemorrhagic stroke (i.e., male sex, age ≥ 75 years, Charlson comorbidity index ≥ 3, and hypertension) and reduces the incidence of hemorrhagic stroke.

KW - Atrial fibrillation

KW - Hemorrhagic stroke

KW - Influenza vaccination

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U2 - 10.1016/j.ijcard.2016.12.074

DO - 10.1016/j.ijcard.2016.12.074

M3 - Article

VL - 232

SP - 315

EP - 323

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -