human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose — There is controversy on the relationship of the type of atrial fibrillation ( AF ) to stroke . Although several studies show that patients with paroxysmal AF ( PAF ) have a stroke risk similar to those with persistent or permanent AF , recent studies suggest that PAF is associated with a lower rate of stroke . Limited data on stroke risk associated with PAF are evident in Asian population s. Methods — The Registry Study of Atrial Fibrillation Patients in Fushimi-ku ( Fushimi AF Registry ) is a community-based survey of patients with AF in Fushimi-ku , Kyoto , Japan . Patients were categorized into 2 types of AF : PAF or sustained ( persistent or permanent ) AF . We compared clinical events between PAF  ( n=1588 ) and  sustained AF ( n=1716 ) . Results — Patients with PAF were younger , had less comorbidities , and received oral anticoagulants ( OAC ) less commonly . A lower risk of stroke/systemic embolism during follow-up period in the patients with PAF was consistently observed ( non-OAC users : hazard ratio , 0.45 ; 95 % confidence intervals , 0.27–0.75 ; P<0.01 and OAC users : hazard ratio , 0.59 ; 95 % confidence interval , 0.35–0.93 ; P=0.03 ) . The composite end point of stroke/systemic embolism/all-cause mortality was also lower in PAF , whether among OAC users ( hazard ratio , 0.77 ; 95 % confidence interval , 0.59–0.99 ; P=0.046 ) or non-OAC users ( hazard ratio , 0.59 ; 95 % confidence interval , 0.46–0.75 ; P<0.01 ) . On multivariate analysis , PAF was an independent predictor of lower stroke/systemic embolism risk . Conclusions — In this large cohort of Japanese patients with AF , PAF was independently associated with lower incidence of stroke/systemic embolism than sustained AF . This may aid decision making for anticoagulation , especially in those patients with AF with few stroke risk factors . Clinical Trial Registration — URL : http://www.umin.ac.jp/ctr/index.htm . Unique identifier : UMIN000005834 BACKGROUND There remains uncertainty about the risk of cardiovascular events in stable out patients with a history of myocardial infa rct ion ( MI ) , stroke , and atrial fibrillation in Japan . METHODS AND RESULTS In the Japan Thrombosis Registry for Atrial Fibrillation , Coronary , or Cerebrovascular Events ( J-TRACE ) , a nationwide prospect i ve cohort of stable out patients with a history of MI ( n=2,291 ) , stroke ( n=3,554 ) , and /or atrial fibrillation ( n=2,242 ) , 1-year follow-up data were available for 7,513 of 8,087 patients ( follow-up rate : 92.9 % ) . The primary endpoint ( death/MI/stroke ) was reported in 3.53 events per 100 person-years ( 95 % confidence interval [ CI ] : 3.11 - 3.99 ) within 1 year . The rates of all-cause death , death from stroke , and death from MI within 1 year were 1.35 ( 95%CI : 1.10 - 1.65 ) , 0.15 ( 95%CI : 0.08 - 0.27 ) , and 0.06 ( 95%CI : 0.02 - 0.14 ) per 100 person-years , respectively . The rate of non-fatal stroke was 1.85 ( 95%CI : 1.55 - 2.19 ) , while that of non-fatal MI was 0.33 ( 95%CI : 0.21 - 0.49 ) . The rate of non-fatal stroke was highest among stroke patients ( 2.95 ; 95%CI : 2.39 - 3.60 per 100 person-years ) , while that of non-fatal MI was similar across all disease categories . Investigator-decided serious non-fatal bleeding events occurred in 0.21 events ( 95%CI : 0.12 - 0.34 ) per 100 person-years . CONCLUSIONS In this large , nationwide Japanese registry , the highest stroke event rate was seen in patients with a history of stroke Background and Purpose — Reported rates of oral anticoagulation ( OAC ) use have been low among Chinese patients with atrial fibrillation ( AF ) . With improved awareness , changing guidelines , this situation may be changing over time . We aim ed to explore the current status and time trends of OAC use in Beijing . Methods — We used the data set from the Chinese Atrial Fibrillation Registry ( CAFR ) , a prospect i ve , multicenter , hospital-based registry study involving 20 tertiary and 12 nontertiary hospitals in Beijing . A total of 11 496 patients with AF were enrolled from 2011 to 2014 . Results — Seven thous and nine hundred seventy-seven eligible patients were included in this ancillary study . The proportions of OAC use were 36.5 % ( 2268/6210 ) , 28.5 % ( 333/1168 ) , and 21.4 % ( 128/599 ) for patients with CHA2DS2-VASc scores ≥2 , 1 , and 0 , respectively . Persistent AF , history of stroke/transient ischemic attack/peripheral embolism , diabetes mellitus , higher body mass index , and tertiary hospital management were factors positively associated with OAC use , whereas older age , previous bleeding , hypercholesterolemia , and established coronary artery disease were factors negatively associated with OAC use . Among patients with CHADS2 scores ≥2 and CHA2DS2-VASc scores ≥2 , the proportion of OAC use increased from 31.3 % to 64.5 % and 30.2 % to 57.7 % , respectively , from 2011 to 2014 . Variation in OAC  use was substantial among different hospitals . Conclusions — An improvement of OAC use among Chinese patients with AF in Beijing is observed in recent years although only 36.5 % of patients with CHA2DS2-VASc score ≥2 received OAC . However , variations between different hospitals were large , suggesting that better education and awareness are needed to improve efforts for stroke prevention among AF patients . Clinical Trial Registration — URL : http://www.chictr.org.cn/showproj.aspx?proj=5831 . Unique identifier : ChiCTR-OCH-13003729 BACKGROUND Although hyperuricemia has been reported to be a risk factor of stroke , the relationship between hyperuricemia and stroke in patients with atrial fibrillation ( AF ) remains uncertain . The goal of the present study was to investigate whether hyperuricemia could potentially refine clinical risk stratification in AF . METHODS This study used the " National Health Insurance Research Data base " in Taiwan . A total of 7601 AF patients who did not receive antiplatelet agents or oral anticoagulants were identified as the study population . Hyperuricemia was defined as having at least one episode of gout attack necessitating long-term treatment with uric acid-lowering agents . The association between hyperuricemia and ischemic stroke was analyzed . RESULTS During the follow up of 3.0±2.7 years , 1116 patients ( 14.7 % ) experienced ischemic stroke with an annual rate of around 4.9 % . Hyperuricemia significantly predicts stroke , with a hazard ratio ( HR ) of 1.280 after adjusting for CHA2DS2-VASc score and other comorbidities . Among the 376 patients with a CHA2DS2VASc score of 0 , hyperuricemia can further stratify them into 2 groups with different stroke rates ( 7.1 % versus 1.3 % , p=0.020 ) . The adjusted HR of hyperuricemia in predicting ischemic stroke diminished from 7.491 for patients with a CHA2DS2-VASc score of 0 to 1.659 for those with a score of 3 , and became insignificant for patients with a score ≥4 . CONCLUSIONS Hyperuricemia was a significant risk factor of stroke which could potentially refine the clinical risk stratification in AF . It deserves a prospect i ve trial to investigate whether it would change the current strategy for stroke preventions using oral anticoagulants A prospect i ve registry was made of all patients hospitalized with atrial fibrillation ( AF ) in the State of Qatar from 1991 to 2010 .  Clinical characteristics , management , and outcomes were compared according to ethnicity ( Middle Eastern Arab vs South Asian ) . During this 20-year period , 2857 Arabs and 548 Asians were hospitalized for AF . Arabs were 9 years older and more likely to have hypertension , diabetes mellitus ( DM ) , chronic renal impairment , and dyslipidemia than the Asians . Valvular heart disease and acute coronary syndromes were more common among Asians , while congestive heart failure was more common in Arabs . The overall inhospital mortality was lower in Asians than that of Arabs , while stroke rates were comparable . There was an increase in the prevalence of DM and hypertension in both the groups in the latter years of the study period , but there was no change in mortality trends . Our findings underscore the need to study AF according to ethnicity BACKGROUND Evidence regarding the relationship between different levels of alcohol consumption and the risk of atrial fibrillation ( AF )  is currently limited in Asian population s. METHODS AND RESULTS Between 1991 and 1995 , a total of 8,602 Japanese men and women aged 30 - 80 years took part in the first examination of the Circulatory Risk in Communities Study ( CIRCS ) , a population -based cohort study in Japanese communities .  An interviewer obtained detailed information on weekly alcohol intake . During the follow-up period , the incidence of AF was ascertained from annual ECG records , the subject 's medical history of AF , and cardiovascular disease surveillance . The hazard ratios ( HRs ) of incident AF and the 95 % confidence intervals ( CIs ) relative to the never-drinking group were calculated with adjustment for potential confounding factors by using the Cox proportional hazard model . During a median follow-up period of 6.4 years , 296 incidents of AF occurred . A higher incidence of AF was observed among participants with an ethanol intake > 69g/day , compared with never-drinkers . Compared with the never-drinkers , the multivariable-adjusted HRs ( CIs ) of past , light ( < 23g/day ) , light-moderate ( 23 - 46g/day ) , moderate ( 46 - 69g/day ) , and heavy ( > 69g/day ) drinkers were 1.30 ( 0.68 - 2.49 ) , 0.89 ( 0.60 - 1.32 ) , 1.19 ( 0.73 - 1.95 ) , 1.36 ( 0.79 - 2.35 ) , and 2.90 ( 1.61 - 5.23 ) , respectively . CONCLUSIONS Heavy alcohol consumption is associated with a higher risk of AF Background There is limited information on prevalent and incident atrial fibrillation in Chinese . We aim ed to investigate the prevalence , incidence , management and risks of atrial fibrillation in an elderly Chinese population . Methods In a population —based prospect i ve study in elderly ( ≥60 years ) Chinese , we performed cardiovascular health examinations including a 12-lead electrocardiogram at baseline in 3,922 participants  and biennially during follow-up in 2,017 participants . We collected information on vital status during the whole follow-up period . Results The baseline prevalence of atrial fibrillation was 2.0 % ( n = 34 ) in 1718 men and 1.6 % ( n = 36 ) in 2204 women . During a median 3.8 years of follow-up , the incidence rate of atrial fibrillation ( n = 34 ) was 4.9 per 1000 person-years ( 95 % confidence interval [ CI ] , 3.4–6.9 ) . In univariate analysis , both the prevalence and incidence of atrial fibrillation were higher with age advancing ( P < 0.0001 ) and in the presence of coronary heart disease ( P ≤ 0.02 ) . Of the 104 prevalent and incident cases of atrial fibrillation , only 1 ( 1.0 % ) received anticoagulant therapy ( warfarin ) . These patients with atrial fibrillation , compared with those with sinus rhythm , had significantly higher risks of all-cause ( n = 261 , hazard ratio [ HR ] 1.87 , 95 % CI , 1.09–3.20 , P = 0.02 ) , cardiovascular ( n = 136 , HR 3.78 , 95 % CI 2.17–6.58 , P < 0.0001 ) and stroke mortality ( n = 44 , HR 6.31 , 95 % CI 2.81–14.19 , P = 0.0003 ) . Conclusions Atrial fibrill 
    Output:
    
agent
: The incidence and prevalence of AF have increased in recent years , although great variability still exists in Asian countries .
Variability in annual IS risk in patients with AF was apparent between hospital‐ and community‐based studies .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose — There is controversy on the relationship of the type of atrial fibrillation ( AF ) to stroke . Although several studies show that patients with paroxysmal AF ( PAF ) have a stroke risk similar to those with persistent or permanent AF , recent studies suggest that PAF is associated with a lower rate of stroke . Limited data on stroke risk associated with PAF are evident in Asian population s. Methods — The Registry Study of Atrial Fibrillation Patients in Fushimi-ku ( Fushimi AF Registry ) is a community-based survey of patients with AF in Fushimi-ku , Kyoto , Japan . Patients were categorized into 2 types of AF : PAF or sustained ( persistent or permanent ) AF . We compared clinical events between PAF  ( n=1588 ) and  sustained AF ( n=1716 ) . Results — Patients with PAF were younger , had less comorbidities , and received oral anticoagulants ( OAC ) less commonly . A lower risk of stroke/systemic embolism during follow-up period in the patients with PAF was consistently observed ( non-OAC users : hazard ratio , 0.45 ; 95 % confidence intervals , 0.27–0.75 ; P<0.01 and OAC users : hazard ratio , 0.59 ; 95 % confidence interval , 0.35–0.93 ; P=0.03 ) . The composite end point of stroke/systemic embolism/all-cause mortality was also lower in PAF , whether among OAC users ( hazard ratio , 0.77 ; 95 % confidence interval , 0.59–0.99 ; P=0.046 ) or non-OAC users ( hazard ratio , 0.59 ; 95 % confidence interval , 0.46–0.75 ; P<0.01 ) . On multivariate analysis , PAF was an independent predictor of lower stroke/systemic embolism risk . Conclusions — In this large cohort of Japanese patients with AF , PAF was independently associated with lower incidence of stroke/systemic embolism than sustained AF . This may aid decision making for anticoagulation , especially in those patients with AF with few stroke risk factors . Clinical Trial Registration — URL : http://www.umin.ac.jp/ctr/index.htm . Unique identifier : UMIN000005834 BACKGROUND There remains uncertainty about the risk of cardiovascular events in stable out patients with a history of myocardial infa rct ion ( MI ) , stroke , and atrial fibrillation in Japan . METHODS AND RESULTS In the Japan Thrombosis Registry for Atrial Fibrillation , Coronary , or Cerebrovascular Events ( J-TRACE ) , a nationwide prospect i ve cohort of stable out patients with a history of MI ( n=2,291 ) , stroke ( n=3,554 ) , and /or atrial fibrillation ( n=2,242 ) , 1-year follow-up data were available for 7,513 of 8,087 patients ( follow-up rate : 92.9 % ) . The primary endpoint ( death/MI/stroke ) was reported in 3.53 events per 100 person-years ( 95 % confidence interval [ CI ] : 3.11 - 3.99 ) within 1 year . The rates of all-cause death , death from stroke , and death from MI within 1 year were 1.35 ( 95%CI : 1.10 - 1.65 ) , 0.15 ( 95%CI : 0.08 - 0.27 ) , and 0.06 ( 95%CI : 0.02 - 0.14 ) per 100 person-years , respectively . The rate of non-fatal stroke was 1.85 ( 95%CI : 1.55 - 2.19 ) , while that of non-fatal MI was 0.33 ( 95%CI : 0.21 - 0.49 ) . The rate of non-fatal stroke was highest among stroke patients ( 2.95 ; 95%CI : 2.39 - 3.60 per 100 person-years ) , while that of non-fatal MI was similar across all disease categories . Investigator-decided serious non-fatal bleeding events occurred in 0.21 events ( 95%CI : 0.12 - 0.34 ) per 100 person-years . CONCLUSIONS In this large , nationwide Japanese registry , the highest stroke event rate was seen in patients with a history of stroke Background and Purpose — Reported rates of oral anticoagulation ( OAC ) use have been low among Chinese patients with atrial fibrillation ( AF ) . With improved awareness , changing guidelines , this situation may be changing over time . We aim ed to explore the current status and time trends of OAC use in Beijing . Methods — We used the data set from the Chinese Atrial Fibrillation Registry ( CAFR ) , a prospect i ve , multicenter , hospital-based registry study involving 20 tertiary and 12 nontertiary hospitals in Beijing . A total of 11 496 patients with AF were enrolled from 2011 to 2014 . Results — Seven thous and nine hundred seventy-seven eligible patients were included in this ancillary study . The proportions of OAC use were 36.5 % ( 2268/6210 ) , 28.5 % ( 333/1168 ) , and 21.4 % ( 128/599 ) for patients with CHA2DS2-VASc scores ≥2 , 1 , and 0 , respectively . Persistent AF , history of stroke/transient ischemic attack/peripheral embolism , diabetes mellitus , higher body mass index , and tertiary hospital management were factors positively associated with OAC use , whereas older age , previous bleeding , hypercholesterolemia , and established coronary artery disease were factors negatively associated with OAC use . Among patients with CHADS2 scores ≥2 and CHA2DS2-VASc scores ≥2 , the proportion of OAC use increased from 31.3 % to 64.5 % and 30.2 % to 57.7 % , respectively , from 2011 to 2014 . Variation in OAC  use was substantial among different hospitals . Conclusions — An improvement of OAC use among Chinese patients with AF in Beijing is observed in recent years although only 36.5 % of patients with CHA2DS2-VASc score ≥2 received OAC . However , variations between different hospitals were large , suggesting that better education and awareness are needed to improve efforts for stroke prevention among AF patients . Clinical Trial Registration — URL : http://www.chictr.org.cn/showproj.aspx?proj=5831 . Unique identifier : ChiCTR-OCH-13003729 BACKGROUND Although hyperuricemia has been reported to be a risk factor of stroke , the relationship between hyperuricemia and stroke in patients with atrial fibrillation ( AF ) remains uncertain . The goal of the present study was to investigate whether hyperuricemia could potentially refine clinical risk stratification in AF . METHODS This study used the " National Health Insurance Research Data base " in Taiwan . A total of 7601 AF patients who did not receive antiplatelet agents or oral anticoagulants were identified as the study population . Hyperuricemia was defined as having at least one episode of gout attack necessitating long-term treatment with uric acid-lowering agents . The association between hyperuricemia and ischemic stroke was analyzed . RESULTS During the follow up of 3.0±2.7 years , 1116 patients ( 14.7 % ) experienced ischemic stroke with an annual rate of around 4.9 % . Hyperuricemia significantly predicts stroke , with a hazard ratio ( HR ) of 1.280 after adjusting for CHA2DS2-VASc score and other comorbidities . Among the 376 patients with a CHA2DS2VASc score of 0 , hyperuricemia can further stratify them into 2 groups with different stroke rates ( 7.1 % versus 1.3 % , p=0.020 ) . The adjusted HR of hyperuricemia in predicting ischemic stroke diminished from 7.491 for patients with a CHA2DS2-VASc score of 0 to 1.659 for those with a score of 3 , and became insignificant for patients with a score ≥4 . CONCLUSIONS Hyperuricemia was a significant risk factor of stroke which could potentially refine the clinical risk stratification in AF . It deserves a prospect i ve trial to investigate whether it would change the current strategy for stroke preventions using oral anticoagulants A prospect i ve registry was made of all patients hospitalized with atrial fibrillation ( AF ) in the State of Qatar from 1991 to 2010 .  Clinical characteristics , management , and outcomes were compared according to ethnicity ( Middle Eastern Arab vs South Asian ) . During this 20-year period , 2857 Arabs and 548 Asians were hospitalized for AF . Arabs were 9 years older and more likely to have hypertension , diabetes mellitus ( DM ) , chronic renal impairment , and dyslipidemia than the Asians . Valvular heart disease and acute coronary syndromes were more common among Asians , while congestive heart failure was more common in Arabs . The overall inhospital mortality was lower in Asians than that of Arabs , while stroke rates were comparable . There was an increase in the prevalence of DM and hypertension in both the groups in the latter years of the study period , but there was no change in mortality trends . Our findings underscore the need to study AF according to ethnicity BACKGROUND Evidence regarding the relationship between different levels of alcohol consumption and the risk of atrial fibrillation ( AF )  is currently limited in Asian population s. METHODS AND RESULTS Between 1991 and 1995 , a total of 8,602 Japanese men and women aged 30 - 80 years took part in the first examination of the Circulatory Risk in Communities Study ( CIRCS ) , a population -based cohort study in Japanese communities .  An interviewer obtained detailed information on weekly alcohol intake . During the follow-up period , the incidence of AF was ascertained from annual ECG records , the subject 's medical history of AF , and cardiovascular disease surveillance . The hazard ratios ( HRs ) of incident AF and the 95 % confidence intervals ( CIs ) relative to the never-drinking group were calculated with adjustment for potential confounding factors by using the Cox proportional hazard model . During a median follow-up period of 6.4 years , 296 incidents of AF occurred . A higher incidence of AF was observed among participants with an ethanol intake > 69g/day , compared with never-drinkers . Compared with the never-drinkers , the multivariable-adjusted HRs ( CIs ) of past , light ( < 23g/day ) , light-moderate ( 23 - 46g/day ) , moderate ( 46 - 69g/day ) , and heavy ( > 69g/day ) drinkers were 1.30 ( 0.68 - 2.49 ) , 0.89 ( 0.60 - 1.32 ) , 1.19 ( 0.73 - 1.95 ) , 1.36 ( 0.79 - 2.35 ) , and 2.90 ( 1.61 - 5.23 ) , respectively . CONCLUSIONS Heavy alcohol consumption is associated with a higher risk of AF Background There is limited information on prevalent and incident atrial fibrillation in Chinese . We aim ed to investigate the prevalence , incidence , management and risks of atrial fibrillation in an elderly Chinese population . Methods In a population —based prospect i ve study in elderly ( ≥60 years ) Chinese , we performed cardiovascular health examinations including a 12-lead electrocardiogram at baseline in 3,922 participants  and biennially during follow-up in 2,017 participants . We collected information on vital status during the whole follow-up period . Results The baseline prevalence of atrial fibrillation was 2.0 % ( n = 34 ) in 1718 men and 1.6 % ( n = 36 ) in 2204 women . During a median 3.8 years of follow-up , the incidence rate of atrial fibrillation ( n = 34 ) was 4.9 per 1000 person-years ( 95 % confidence interval [ CI ] , 3.4–6.9 ) . In univariate analysis , both the prevalence and incidence of atrial fibrillation were higher with age advancing ( P < 0.0001 ) and in the presence of coronary heart disease ( P ≤ 0.02 ) . Of the 104 prevalent and incident cases of atrial fibrillation , only 1 ( 1.0 % ) received anticoagulant therapy ( warfarin ) . These patients with atrial fibrillation , compared with those with sinus rhythm , had significantly higher risks of all-cause ( n = 261 , hazard ratio [ HR ] 1.87 , 95 % CI , 1.09–3.20 , P = 0.02 ) , cardiovascular ( n = 136 , HR 3.78 , 95 % CI 2.17–6.58 , P < 0.0001 ) and stroke mortality ( n = 44 , HR 6.31 , 95 % CI 2.81–14.19 , P = 0.0003 ) . Conclusions Atrial fibrill 
    Output:
    