Abstract 4147213: Does Well-Controlled, Recent-Onset Diabetes Increase Stroke Hazard in Atrial Fibrillation? A Population-Based Cohort Study
Bibliographic record
Abstract
Introduction: Stroke prevention with anticoagulation is an important aspect of atrial fibrillation (AF) management. Anticoagulation is often based on the premise that the risk of stroke increases with each additional CHA2DS2VASc risk factor. Diabetes is accepted as a risk factor for stroke in AF, but the threshold at which stroke risk increases is uncertain. Specifically, it is unknown if AF patients with recent-onset well-controlled diabetes (ROWCD) are at increased risk of stroke in AF compared to AF patients without diabetes. Hypothesis: We hypothesize that patients with AF and diabetes of <5 years’ duration with glycated hemoglobin (HbA1c) ≤7% who do not use insulin (henceforth designated as the ROWCD group) do not have a significantly different adjusted hazard of stroke than AF patients without diabetes. Methods/Approach: Using linked administrative databases in Ontario, Canada, we conducted a population-based retrospective cohort study of patients ≥66 years who had a new AF diagnosis between Apr 1 2013 and Mar 31 2022. Exclusion criteria included insulin use. Cause-specific hazard regression was used to quantify the adjusted hazard ratio (HR) for stroke over 2 years of follow-up in patients with AF plus diabetes relative to AF patients without diabetes (adjusting for baseline stroke risk factors and time-varying anticoagulation status). The analysis was repeated after excluding people with diabetes of ≥5 years duration, HbA1c >7%, or missing HbA1c data (to generate the ROWCD subset). Results/Data: The primary analysis included 233,692 patients with AF (mean age 78.8 years, 50.9% male), of whom 64,972 (27.8%) had diabetes. Diabetes was associated with an adjusted HR of 1.15 (1.08-1.22) for stroke in the full cohort (p< 0.001). After excluding people with diabetes of ≥5 years duration, HbA1c >7% or missing HbA1c, there were 7,415 patients with ROWCD. Mean diabetes duration was 3.0 years, mean HbA1c was 6.2%, with 38.5% metformin use, 10.6% dipeptidyl peptidase-4 inhibitor use, and 5.3% sulfonylurea use. There were 3,503 (2.1%) strokes in the non-diabetes group and 139 (1.9%) in the ROWCD group. ROWCD was not significantly associated with adjusted stroke hazard (HR 0.96, 95% CI 0.81-1.13, p=0.61). Conclusions: These findings suggest that people with AF who have ROWCD may not warrant a point on the CHA2DS2VASc score, as this subset of diabetes is not associated with increased hazard of stroke in AF.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".