{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T01:16:12Z","timestamp":1788830172530,"version":"build-2803163510"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,3,3]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Atrial fibrillation (AF) is a major cause of ischemic stroke (IS), and this risk can be substantially reduced with oral anticoagulants (OACs). Using the population\u2010based ARCOS (Auckland Regional Community Stroke) study, we investigated the temporal trends in AF\u2010associated IS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We analyzed ARCOS IV (March 2011\u2013February 2012) and ARCOS V (September 2020\u2013August 2021). AF\u2010associated IS incidence was compared using Poisson exact methods. Regional OAC dispensing trends were also evaluated. Propensity score\u2013weighted logistic regression estimated the marginal association between cohort and AF\u2010associated IS after standardizing for vascular risk factors. Interaction tests were performed for ethnicity, and sex\u2010specific differences were assessed using heterogeneity testing. OAC\u2010associated intracerebral hemorrhage rates were also examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Among 1694 (ARCOS IV) and 1982 (ARCOS V) IS cases, the proportion of AF\u2010associated IS declined from 32.4% to 21.5% (\u221210.8% [95% CI \u221213.7 to \u22128.0],\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.0001). Crude AF\u2010associated IS incidence fell from 49.0 to 32.7 per 100\u2009000 population. A larger decline occurred in women (relative risk, 0.56) than men (relative risk, 0.76;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      =0.02 for heterogeneity). Temporal reductions differed by ethnicity, with greater decline in the \u201cOther\u201d ethnicity categories, but not in M\u0101ori or Pacific peoples. During the same period, patients dispensed OACs increased from 1094 to 1928 per 100\u2009000 (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). OAC\u2010associated intracerebral hemorrhage increased from 2.1 to 3.6 per 100\u2009000, equating to 11 IS cases prevented per excess intracerebral hemorrhage.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p xml:lang=\"en\">AF\u2010associated IS incidence declined in Auckland between 2012 and 2021, during a period of substantially increased community OAC use. Persistent ethnic inequities and sex\u2010specific variation highlight the need for improved AF detection, risk stratification, and prevention strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.045260","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T12:20:15Z","timestamp":1771590015000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Declining Incidence of Atrial Fibrillation\u2013Associated Ischemic Stroke in Auckland, New Zealand (2012 Versus 2021)"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2256-6470","authenticated-orcid":false,"given":"Karim M.","family":"Mahawish","sequence":"first","affiliation":[{"name":"Health New Zealand \u2010 Te Whatu Ora Counties Health","place":["Auckland, New Zealand"]},{"name":"Auckland University of Technology","place":["Auckland, New Zealand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0869-2083","authenticated-orcid":false,"given":"Rita","family":"Krishnamurthi","sequence":"additional","affiliation":[{"name":"Auckland University of Technology","place":["Auckland, New Zealand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2077-8464","authenticated-orcid":false,"given":"Alan","family":"Davis","sequence":"additional","affiliation":[{"name":"National Stroke Network","place":["Te Whatu Ora, New Zealand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8722-3511","authenticated-orcid":false,"given":"Claudia","family":"Zagreanu","sequence":"additional","affiliation":[{"name":"Auckland University of Technology","place":["Auckland, New Zealand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8100-3120","authenticated-orcid":false,"given":"Irene","family":"Zeng","sequence":"additional","affiliation":[{"name":"Auckland University of Technology","place":["Auckland, New Zealand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7712-6750","authenticated-orcid":false,"given":"Harvey D.","family":"White","sequence":"additional","affiliation":[{"name":"Auckland City Hospital","place":["Auckland, New Zealand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6372-1740","authenticated-orcid":false,"given":"Valery","family":"Feigin","sequence":"additional","affiliation":[{"name":"Auckland University of Technology","place":["Auckland, New Zealand"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/1747493019897870"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/1747493021995592"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/2047487316674830"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-146-12-200706190-00007"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae176"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1080\/03007995.2021.1897555"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1159\/000546212"},{"key":"e_1_3_2_9_2","first-page":"35","article-title":"The changing use of anticoagulants in New Zealand","volume":"135","author":"Harper P","year":"2022","unstructured":"Harper P, Chang A, Stephens M. The changing use of anticoagulants in New Zealand. N Z Med J. 2022;135:35\u201343.","journal-title":"N Z Med J"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.26635\/6965.6846"},{"key":"e_1_3_2_11_2","unstructured":"Stats NZ . Census Population Counts (by Ethnic Group Age and M\u0101ori Descent) and Dwelling Counts. 2023. https:\/\/www.stats.govt.nz\/information\u2010releases\/2023\u2010census\u2010population\u2010counts\u2010by\u2010ethnic\u2010group\u2010age\u2010and\u2010maori\u2010descent\u2010and\u2010dwelling\u2010counts\/."},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanwpc.2025.101508"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/1747493019884528"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.119.005969"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1651587"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.6607"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.24.1.35"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4780100317"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.09-1584"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-147-8-200710160-00010-w1"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.029081"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae198"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.116.013880"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.125.045260","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T11:09:30Z","timestamp":1782990570000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.125.045260"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,3]]},"references-count":22,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,3,3]]}},"alternative-id":["10.1161\/JAHA.125.045260"],"URL":"https:\/\/doi.org\/10.1161\/jaha.125.045260","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,3]]},"assertion":[{"value":"2025-07-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e045260"}}