Clinical studyAtrial fibrillation as a risk factor for stroke recurrence☆
Section snippets
Design and sample
We performed a retrospective cohort study of stroke patients admitted to the University Hospital Marqués de Valdecilla, a 1000-bed teaching facility serving a population of 500,000 in the region of Cantabria, in northern Spain. We identified all patients admitted with acute cerebrovascular disease from January 1, 1992, through December 31, 1994, by searching the hospital’s computerized database. Patients were included in the study if the following criteria were fulfilled: rapidly developing
Results
Of the 915 patients who met inclusion criteria, 86 (9%) had a fatal index stroke. Of the 829 surviving patients in the final study cohort (Table 1 ), 163 (20%) had a recurrent stroke (including 47 [6%] with fatal strokes), 63 (8%) died of cardiovascular diseases other than stroke, 102 (12%) died of noncardiovascular causes, and 47 (6%) died of unknown causes. The median follow-up of the whole cohort was 2.9 years (range, 0 to 8.6 years). Three hundred and six (37%) of the 829 patients had
Stroke recurrence in patients with atrial fibrillation who were not anticoagulated
Among the 203 patients with atrial fibrillation who were not anticoagulated, 54 (27%) had a recurrent stroke during follow-up, compared with 17% (90/523) of those in normal sinus rhythm (P <0.0001; Figure 1 )
In comparison with patients in sinus rhythm, patients with atrial fibrillation during the index hospitalization had an increased risk of stroke recurrence, particularly for severe strokes, when stratified by age (Figure 2 ; Table 2 ). The recurrence rate appeared to be higher during the
Multivariate analysis
Advanced age and atrial fibrillation in the absence of anticoagulation were the only factors that were independently associated with stroke recurrence. In comparison with younger patients, those aged 70 years or more had a 1.5-fold greater risk of stroke recurrence (95% confidence interval [CI]: 1.0 to 2.2; P = 0.04) and a 2.1-fold greater risk of recurrent severe stroke (95% CI: 1.3 to 3.5; P = 0.002).
Patients with atrial fibrillation had a 2.1-fold increased risk of recurrent stroke (95% CI:
Stroke recurrence in patients with atrial fibrillation who were anticoagulated
Among the 103 patients with atrial fibrillation who survived the index stroke and who received anticoagulation, 19 (18%) had a new stroke during follow-up (compared with 27% of nonanticoagulated patients with atrial fibrillation). Patients with atrial fibrillation who were given anticoagulants were younger (mean [± SD] age, 71 ± 6 years vs. 78 ± 7 years, P <0.001), had a higher frequency of heart failure (40% [41/103] vs. 22% [44/203], P = 0.001), and had fewer disabling strokes (36% [37/103]
Discussion
The effect of atrial fibrillation on stroke recurrence has been uncertain. In a cross-sectional study, atrial fibrillation was more frequent in patients admitted with recurrent strokes than in patients with a first stroke (24% vs. 16%); long-term follow-up was not provided (7). Lai et al. followed 621 patients with ischemic stroke for an average of 24 months and found that atrial fibrillation was associated with stroke recurrence (6). However, others have reported negative results. In a cohort
Acknowledgements
We acknowledge the dedication of the physicians and staff who cared for the patients, particularly those in the Services of Internal Medicine and Neurology, and the administrative collaboration of the Servicios de Admisión from the Hospitals Marqués de Valdecilla and Sierrallana.
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Unveiling the antecedent configurations of cerebral infarction recurrence using qualitative comparative analysis
2024, Journal of NeurorestoratologyAtrial Cardiopathy: Redefining Stroke Risk Beyond Atrial Fibrillation
2023, American Journal of CardiologyUsability of a smartwatch for atrial fibrillation detection in older adults after stroke
2022, Cardiovascular Digital Health JournalCitation Excerpt :Fortunately, treatment options for stroke prevention in AF patients have been shown to be highly effective and safe, which further highlights the importance of timely diagnosis and treatment of the arrhythmia.7,8 This is especially important in patients who have already experienced a stroke, as they are a particularly vulnerable population already at higher risk for recurrent stroke, and risk is further exacerbated if they have AF.9 Standard of care in patients after a stroke, and especially in patients whose strokes are of undetermined origin, entails routine cardiac rhythm monitoring, which most often takes the form of a device with several wires affixed to the patient’s chest with adhesive gel.10
Incidence and Mortality Trends of Atrial Fibrillation/Atrial Flutter in the United States 1990 to 2017
2021, American Journal of CardiologyCitation Excerpt :In the US National Cardiovascular Data Registry of outpatients with AF, less than one half of high-risk patients (defined as those with CHA2DS2-VASc score ≥ 4) were receiving anticoagulation.23 It has been shown that AF patients not treated with anticoagulation had 2.1-fold increased risk of recurrent stroke and 2.4-fold increase risk of recurrent severe stroke.24 Additionally, it is known that genetics confer survival advantage to females over males for most disease states except autoimmune diseases.25,26
Antithrombotic treatment for stroke prevention in atrial fibrillation: The Asian agenda
2015, International Journal of CardiologyCitation Excerpt :Stroke kills 20% of such patients and disables 60% of survivors [21]. Furthermore, stroke survivors with AF are more likely than those without to have another stroke [20,22]. The adverse impact of AF is underscored by excess mortality in both men and women with AF [23].
Anticoagulant treatment in patients with atrial fibrillation and ischemic stroke
2015, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :Subgroup analysis of the 65- to 75-year-olds showed no statistically significant changes (Fig 5). AF is a well-known independent risk factor for stroke and stroke recurrence.5-7,9,11,12 Studies have shown that treatment with anticoagulants significantly reduces the risk of ischemic stroke.13-15
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This study was supported by a research grant from the Fundación Pública Marqués de Valdecilla, Santander, Spain.