{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T18:42:31Z","timestamp":1772822551543,"version":"3.50.1"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,2,15]],"date-time":"2024-02-15T00:00:00Z","timestamp":1707955200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The impact of early rhythm control (ERC) combined with healthy lifestyle (HLS) on the risk of ischemic stroke in elderly patients with atrial fibrillation (AF) remains unaddressed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the impact of combined ERC and HLS on the risk of stroke in elderly patients with new-onset AF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using the Korean National Health Insurance Service database, we included patients aged \u226575 years with new-onset AF from January 2009 to December 2016 (<jats:italic>n<\/jats:italic>\u2009=\u200941,315). Patients who received rhythm control therapy within 2 years of AF diagnosis were defined as the ERC group. Non-smoking, non-to-mild alcohol consumption (&amp;lt;105\u2005g\/week), and regular exercise were defined as HLS. Subjects were categorized into four groups: group 1 (without ERC and HLS, <jats:italic>n<\/jats:italic>\u2009=\u200925,093), 2 (HLS alone, <jats:italic>n<\/jats:italic>\u2009=\u20098,351), 3 (ERC alone, <jats:italic>n<\/jats:italic>\u2009=\u20095,565), and 4 (both ERC and HLS, <jats:italic>n<\/jats:italic>\u2009=\u20092,306). We assessed the incidence of ischemic stroke as the primary outcome, along with admissions for heart failure, all-cause death, and the composite of ischemic stroke, admission for heart failure, and all-cause death.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Median follow-up duration of the study cohort was 3.4 years. After adjusting for multiple variables, groups 2 and 3 were associated with a lower stroke risk (adjusted hazard ratio [aHR]: 95% confidence interval [CI]: 0.867, 0.794\u20130.948 and 0.713, 0.637\u20130.798, respectively) than that of group 1. Compared to Group 1, group 4 showed the lowest stroke risk (aHR: 0.694, 95% CI: 0.586\u20130.822) among all groups, followed by group 3 (0.713, 0.637\u20130.798) and group 2 (0.857, 0.794\u20130.948), respectively. Group 4 was associated with the lowest risk of all-cause death (aHR: 0.680, 95% CI: 0.613\u20130.754) and the composite outcome (aHR: 0.708, 95% CI: 0.649\u20130.772).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>ERC and HLS were associated with a lower risk of ischemic stroke in elderly patients with new-onset AF. Concurrently implementing ERC and maintaining HLS was associated with the lowest risk of death and the composite outcome, with a modest synergistic effect on stroke prevention.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2024.1346414","type":"journal-article","created":{"date-parts":[[2024,2,15]],"date-time":"2024-02-15T04:50:51Z","timestamp":1707972651000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Combination of early rhythm control and healthy lifestyle on the risk of stroke in elderly patients with new-onset atrial fibrillation: a nationwide population-based cohort study"],"prefix":"10.3389","volume":"11","author":[{"given":"Woo-Hyun","family":"Lim","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"So-Ryoung","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eue-Keun","family":"Choi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seung-Woo","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyung-Do","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seil","family":"Oh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory Y. H.","family":"Lip","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,2,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e2255838","DOI":"10.1001\/jamanetworkopen.2022.55838","article-title":"Prevalence and incidence of atrial fibrillation among older primary care patients","volume":"6","author":"Khurshid","year":"2023","journal-title":"JAMA Netw Open"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2370","DOI":"10.1001\/jama.285.18.2370","article-title":"Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the anticoagulation and risk factors in atrial fibrillation (atria) study","volume":"285","author":"Go","year":"2001","journal-title":"JAMA"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2455","DOI":"10.1161\/01.cir.96.7.2455","article-title":"Incidence of and risk factors for atrial fibrillation in older adults","volume":"96","author":"Psaty","year":"1997","journal-title":"Circulation"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e006350","DOI":"10.1161\/CIRCEP.118.006350","article-title":"Lifetime risk of atrial fibrillation by race and socioeconomic Status: aric study (atherosclerosis risk in communities)","volume":"11","author":"Mou","year":"2018","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"983","DOI":"10.1161\/01.STR.22.8.983","article-title":"Atrial fibrillation as an independent risk factor for stroke: the Framingham study","volume":"22","author":"Wolf","year":"1991","journal-title":"Stroke"},{"key":"B6","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1016\/s0002-9343(02)01236-6","article-title":"A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew\/Paisley study","volume":"113","author":"Stewart","year":"2002","journal-title":"Am J Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European association for cardio-thoracic surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European society of cardiology (ESC) developed with the special contribution of the European heart rhythm association (EHRA) of the esc","volume":"42","author":"Hindricks","year":"2021","journal-title":"Eur Heart J"},{"key":"B8","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1055\/s-0041-1739411","article-title":"2021 focused update consensus guidelines of the Asia pacific heart rhythm society on stroke prevention in atrial fibrillation: executive summary","volume":"122","author":"Chao","year":"2022","journal-title":"Thromb Haemostasis"},{"key":"B9","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1016\/S0140-6736(14)61774-8","article-title":"50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham heart study: a cohort study","volume":"386","author":"Schnabel","year":"2015","journal-title":"Lancet"},{"key":"B10","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.amjcard.2018.03.028","article-title":"Atrial fibrillation manifestations risk factors and sex differences in a population-based cohort (from the Gutenberg health study)","volume":"122","author":"Magnussen","year":"2018","journal-title":"Am J Cardiol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.1056\/NEJMoa2019422","article-title":"Early rhythm-control therapy in patients with atrial fibrillation","volume":"383","author":"Kirchhof","year":"2020","journal-title":"N Engl J Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"n991","DOI":"10.1136\/bmj.n991","article-title":"Treatment timing and the effects of rhythm control strategy in patients with atrial fibrillation: nationwide cohort study","volume":"373","author":"Kim","year":"2021","journal-title":"Br Med J"},{"key":"B13","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1016\/j.jamda.2019.07.019","article-title":"Health care providers\u2019 advice on lifestyle modification for older adults","volume":"21","author":"Haider","year":"2020","journal-title":"J Am Med Dir Assoc"},{"key":"B14","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1016\/j.jacep.2022.02.014","article-title":"Age and outcomes of early rhythm control in patients with atrial fibrillation: nationwide cohort study","volume":"8","author":"Kim","year":"2022","journal-title":"JACC Clin Electrophysiol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1093\/ije\/dyw253","article-title":"Data resource profile: the national health information database of the national health insurance service in South Korea","volume":"46","author":"Seong S","year":"2017","journal-title":"Int J Epidemiol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"754","DOI":"10.4070\/kcj.2020.0171","article-title":"Cardiovascular research using the Korean national health information database","volume":"50","author":"Choi","year":"2020","journal-title":"Korean Circ J"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e1003659","DOI":"10.1371\/journal.pmed.1003659","article-title":"Association between exercise habits and stroke, heart failure, and mortality in Korean patients with incident atrial fibrillation: a nationwide population-based cohort study","volume":"18","author":"Ahn","year":"2021","journal-title":"PLoS Med"},{"key":"B18","doi-asserted-by":"publisher","first-page":"4759","DOI":"10.1093\/eurheartj\/ehab315","article-title":"Lower risk of stroke after alcohol abstinence in patients with incident atrial fibrillation: a nationwide population-based cohort study","volume":"42","author":"Lee","year":"2021","journal-title":"Eur Heart J"},{"key":"B19","doi-asserted-by":"publisher","first-page":"2238","DOI":"10.3390\/jcm10112238","article-title":"Smoking cessation after diagnosis of new-onset atrial fibrillation and the risk of stroke and death","volume":"10","author":"Lee","year":"2021","journal-title":"J Clin Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.1097\/01.mlr.0000182534.19832.83","article-title":"Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data","volume":"43","author":"Quan","year":"2005","journal-title":"Med Care"},{"key":"B21","doi-asserted-by":"publisher","first-page":"3661","DOI":"10.1002\/sim.6607","article-title":"Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies","volume":"34","author":"Austin","year":"2015","journal-title":"Stat Med"},{"key":"B22","doi-asserted-by":"publisher","first-page":"3083","DOI":"10.1002\/sim.3697","article-title":"Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples","volume":"28","author":"Austin","year":"2009","journal-title":"Stat Med"},{"key":"B23","doi-asserted-by":"publisher","first-page":"e024214","DOI":"10.1161\/JAHA.121.024214","article-title":"Generalizability of the EAST-AFNET 4 trial: assessing outcomes of early rhythm-control therapy in patients with atrial fibrillation","volume":"11","author":"Dickow","year":"2022","journal-title":"J Am Heart Assoc"},{"key":"B24","doi-asserted-by":"publisher","first-page":"2030","DOI":"10.1055\/s-0042-1756355","article-title":"Clinical complexity domains, anticoagulation, and outcomes in patients with atrial fibrillation: a report from the GLORIA-AF registry phase II and III","volume":"122","author":"Romiti","year":"2022","journal-title":"Thromb Haemostasis"},{"key":"B25","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1378\/chest.09-1584","article-title":"Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation","volume":"137","author":"Lip","year":"2010","journal-title":"Chest"},{"key":"B26","doi-asserted-by":"publisher","first-page":"e006212","DOI":"10.1161\/CIRCOUTCOMES.119.006212","article-title":"Net clinical benefit of oral anticoagulation among older adults with atrial fibrillation","volume":"12","author":"Shah","year":"2019","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"B27","doi-asserted-by":"publisher","first-page":"e2242964","DOI":"10.1001\/jamanetworkopen.2022.42964","article-title":"Trends in use of oral anticoagulants in older adults with newly diagnosed atrial fibrillation, 2010\u20132020","volume":"5","author":"Ko","year":"2022","journal-title":"JAMA Netw Open"},{"key":"B28","doi-asserted-by":"publisher","first-page":"e0189495","DOI":"10.1371\/journal.pone.0189495","article-title":"Temporal trends of antithrombotic therapy for stroke prevention in Korean patients with non-valvular atrial fibrillation in the era of non-vitamin K antagonist oral anticoagulants: a nationwide population-based study","volume":"12","author":"Lee","year":"2017","journal-title":"PLoS One"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1160","DOI":"10.1016\/j.hrthm.2011.03.038","article-title":"Smoking and incidence of atrial fibrillation: results from the atherosclerosis risk in communities (ARIC) study","volume":"8","author":"Chamberlain","year":"2011","journal-title":"Heart Rhythm"},{"key":"B30","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1016\/j.jacep.2022.12.002","article-title":"An exercise and physical activity program in patients with atrial fibrillation: the ACTIVE-AF randomized controlled trial","volume":"9","author":"Elliott","year":"2023","journal-title":"JACC Clin Electrophysiol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1056\/NEJMoa1817591","article-title":"Alcohol abstinence in drinkers with atrial fibrillation","volume":"382","author":"Voskoboinik","year":"2020","journal-title":"N Engl J Med"},{"key":"B32","doi-asserted-by":"publisher","first-page":"2159","DOI":"10.1016\/j.jacc.2015.03.002","article-title":"Long-term effect of goal-directed weight management in an atrial fibrillation cohort: a long-term follow-up study (legacy)","volume":"65","author":"Pathak","year":"2015","journal-title":"J Am Coll Cardiol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1929","DOI":"10.1093\/europace\/euy117","article-title":"Prevention and regressive effect of weight-loss and risk factor modification on atrial fibrillation: the REVERSE-AF study","volume":"20","author":"Middeldorp","year":"2018","journal-title":"Europace"},{"key":"B34","doi-asserted-by":"publisher","first-page":"e750","DOI":"10.1161\/CIR.0000000000000748","article-title":"Lifestyle and risk factor modification for reduction of atrial fibrillation: a scientific statement from the American heart association","volume":"141","author":"Chung","year":"2020","journal-title":"Circulation"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1042","DOI":"10.1055\/s-0043-1769612","article-title":"Mobile health-technology-integrated care for atrial fibrillation: a win ratio analysis from the mAFA-II randomized clinical trial","volume":"123","author":"Romiti","year":"2023","journal-title":"Thromb Haemostasis"},{"key":"B36","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1055\/a-1515-9630","article-title":"Adherence to the \u201catrial fibrillation better care\u201d pathway in patients with atrial fibrillation: impact on clinical outcomes-a systematic review and meta-analysis of 285,000 patients","volume":"122","author":"Romiti","year":"2022","journal-title":"Thromb Haemostasis"},{"key":"B37","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1055\/s-0043-1772773","article-title":"Non-vitamin K antagonist oral anticoagulant, warfarin, and ABC pathway adherence on hierarchical outcomes: win ratio analysis of the COOL-AF registry","volume":"124","author":"Treewaree","year":"2024","journal-title":"Thromb Haemostasis"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2024.1346414\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,15]],"date-time":"2024-02-15T04:51:04Z","timestamp":1707972664000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2024.1346414\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,15]]},"references-count":37,"alternative-id":["10.3389\/fcvm.2024.1346414"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2024.1346414","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,15]]},"article-number":"1346414"}}