Aims:
Atrial Fibrillation (AF) treatment in Acute Ischemic Stroke (AIS) is based on thromboembolism prophylaxis regardless AF type, and degree of atrial myopathy. We aim to investigate morbidity and mortality of persistent AF related stroke.
Methods:
Patients admitted with AIS and associated paroxysmal and persistent AF were identified in the 2018 National Inpatient Sample. The study compared in-hospital mortality, stroke-related morbidity, hospital cost, length of stay, and discharge disposition between patients with paroxysmal and persistent AF
Results:
A total of 26,470 patients were admitted for AIS with associated AF. AIS with persistent AF had a longer hospital length of stay (paroxysmal AF Mean(M): 5.7 days, Standard Deviation (SD) 6.8, persistent AF M: 7.4 days, SD 11.9, p<0.001) and in-hospital costs (paroxysmal AF M: $15,449, SD $18,320, persistent AF M: $19,834, SD $23,312, p<0.001). Indirect markers of stroke-related disability, like intracranial hemorrhage (Odds Ratio (OR): 1.9, 95% Confidence Interval (CI): 1.6-2.2), need for gastrostomy (OR: 2.1, 95% CI: 1.8-2.4), and tracheostomy (OR: 3.1, 95% CI: 2.1-4.4) were more associated with AIS and persistent AF (FIGURE 1)
Conclusion:
Persistent AF is associated with poor in-hospital stroke-related outcomes, possibly due to a higher embolic burden. The current recommendation of using only the CHA2DS2-VASc score without AF pattern needs be reevaluated. Further investigation is required to determine the impact of prevention of AF progression on stroke related morbidity.
