Unveiling the Hidden Stroke Threat in Patients with Atrial Fibrillation and Primary Hyperparathyroidism.

Recent ACC/AHA/ACCP/HRS guidelines suggest that patients with Atrial fibrillation (AF) at intermediate to low annual risk of ischemic stroke can benefit from consideration of factors that might modify their risk of stroke. The role of non-traditional risk factors such as primary hyperparathyroidism (PHPT) remains unexplored. In our study, we investigated the potential association between PHPT and the risk of ischemic stroke among patients with AF. Using data from the Nationwide Inpatient Sample Database, a retrospective cohort study focused on the adult population with AF and stratified them based on PHPT presence. Demographic information, comorbidities, and hospitalization details were extracted using ICD-10 codes. Propensity score matching was applied, encompassing over 20 confounding variables, including the risk factors outlined in the CHA2 DS2 -VASc score. Multivariate logistic regression analysis was executed after matching to assess the independent impact of PHPT as an ischemic stroke risk factor. Two thousand fifty-one out of the identified 395,249 AF patients had PHPT. The PHPT group had an average age of 74 and consisted of more females (66.1% vs. 53.0%). After matching, it was observed that the PHPT group had longer hospital stays (5 vs. 4 days) and higher hospitalization charges ($45,126 vs. $36,644). This group exhibited higher rates of ischemic stroke (6.0% vs. 4.4%) and mortality (6.3% vs. 4.9%). Adjusted outcomes showed a 1.4-fold increased risk for ischemic stroke and a 1.32-fold increased risk for mortality in the PHPT cohort. Subgroup analysis showed a higher incidence of mortality in males with a high CHA2 DS2 -VASc score. In conclusion, this study highlights a marked association between PHPT and ischemic stroke in AF patients independent of the conventional CHA2 DS2 -VASc score. The potential mechanisms implicated include vascular changes, cardiac dysfunction, and coagulation cascade alterations. The presence of primary hyperparathyroidism should be taken into consideration when deciding the assessment of thromboembolic risk.