Atrial fibrillation in patients with ischemic stroke: A population-based study

were obtained from the Swedish Stroke Register TIA module (Riksstroke-TIA, RS-TIA); 59 of 72 Swedish hospitals contributed with data to this register. 25 TIA diagnosis was based on a time-based definition, that is, an acute focal neurological deficit of presumed vascular origin with complete remission of symptoms <24 hours irrespective of neuroimaging findings. Data on IS events, registered during the same period of time, were obtained from the stroke module in the Swedish Stroke Register (Riksstroke, RS), 26 to which all Swedish hospitals involved in acute stroke care contributed.Patients aged ≥18 years with International Classification of Diseases Tenth Revision diagnoses of TIA (G45, excluding G45.4) and IS (I63) were included. For patients with >1 stroke during the course of 28 days, only the first event was included. All patients included in this study were taken care of in-hospital. Registered ItemsBoth in RS-TIA and RS, data on demography, risk factors, diagnostic measures, medical treatment at arrival and discharge, and follow-up were registered. In RS-TIA the ABCD2 score was recorded, and in RS details on functional ability and symptoms preadmission, level of medical care, acute stroke treatment, Background and Purpose-Compared with ischemic stroke (IS), the association of atrial fibrillation (AF) with transient ischemic attack (TIA) is less well established. We aimed to assess the proportion of AF in patients with TIA, and these patients' characteristics and secondary preventive treatment in comparison to patients with IS. Methods-Hospital-based data on TIA and IS events, registered from July 2011 to June 2013, were obtained from the Swedish Stroke Register (Riksstroke). A time-based TIA definition (duration of symptoms <24 hours) was applied. AF was registered as present when previously known or diagnosed at the time of assessment. Results-AF was present in 2779 of 14 980 (18.6%) patients with TIA and 13 258 of 44 173 (30.0%) patients with IS. The proportion of AF increased with age, reaching 32.9% in TIA and 46.6% in IS patients ≥85 years. Both in TIA and IS, age, hypertension, a history of stroke, and TIA, and being a nonsmoker were associated with the presence of AF. In contrast to IS, AF was less common in female than in male patients with TIA. At discharge, 64.2% of TIA and 50.0% of IS patients with AF were treated with oral anticoagulants. Proportions of AF patients treated with oral anticoagulants decreased substantially with increasing age. Conclusions-AF is highly prevalent not only in IS but also in TIA patients, with proportions steeply increasing with age. In both TIA and IS, a substantial proportion of patients with AF were discharged without anticoagulant therapy.

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confidence: 99%

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Atrial Fibrillation in Transient Ischemic Attack Versus Ischemic Stroke

Buchwald

Norrving

Petersson

2016

“…3 The prevalence of diagnosed AF in Sweden is currently 3.2% of the adult population (≥20 years). 2 Estimates of the prevalence of AF among patients with ischemic stroke vary between 15% and 38% [4][5][6][7][8] and the true proportion may be even higher because of difficulties in detection of intermittent, silent AF. [9][10][11] Therefore, the effect of AF on stroke occurrence may not be fully appreciated.…”

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confidence: 99%

High Prevalence of Atrial Fibrillation Among Patients With Ischemic Stroke

Friberg

Rosenqvist

Lindgren³

et al. 2014

279

133

Background and Purpose-Atrial fibrillation (AF) is a common cause of devastating but potentially preventable stroke.Estimates of the prevalence of AF among patients with stroke vary considerably because of difficulties in detection of intermittent, silent AF. Better recognition of AF in this patient group may help to identify and offer protection to individuals at risk. Our aim was to determine the nationwide prevalence of AF among patients with ischemic stroke, as well as their use of oral anticoagulation. Methods-Cross-sectional study of unselected patients in cross-linked nationwide Swedish health registers. All 94 083 patients with a diagnosis of ischemic stroke in the nationwide stroke register Riks-Stroke between 2005 and 2010 were studied. Information about previously diagnosed AF, and comorbidity, was obtained from the nationwide Patient Register and cross-referenced with the national Drug Register containing data on all dispensed pharmacological prescriptions in Sweden. Results-Combination of data from Riks-Stroke and from the Patient Register showed that 31 428 (33.4%) patients with ischemic stroke had previously known, or newly diagnosed, AF. Of those, only 16.2% had received warfarin in a pharmacy within 6 months before stroke onset. After hospital discharge, only 35.0% of the survivors received warfarin within the first 3 months after discharge. The likelihood for underlying AF was strongly correlated to the CHA 2 DS 2 -VASC score, which is a point based scheme for assessment of stroke risk in AF but which also predicts likelihood of AF. In this scheme points are given for age, previous stroke or transient ischemic attack, hypertension, heart failure, diabetes, vascular disease and female sex. Conclusions-Access to nationwide register data shows that AF is more common among patients with ischemic stroke than those previously reported. Few patients with stroke and AF had anticoagulant treatment before the event, and few got it after the event. CHA 2 DS 2 -VASc could be a useful monitoring tool to intensify efforts to diagnose AF among patients with cryptogenic stroke. (Stroke. 2014;45:2599-2605.)

“…3 Stroke is the most feared complication in patients with AF because AF is associated with a higher risk of adverse outcome after stroke. 4,5 Several clinical trials have documented the efficacy of oral anticoagulation treatment (OAT) for prevention of cardioembolic stroke in patients with AF. 6 Less is known about the possible effect of preadmission OAT on stroke outcomes.…”

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confidence: 99%

Preadmission Oral Anticoagulant Treatment and Clinical Outcome Among Patients Hospitalized With Acute Stroke and Atrial Fibrillation

Svendsen

Hansen

Brandes

et al. 2014

Background and Purpose-Preadmission oral anticoagulant treatment (OAT) has been linked with less severe stroke and a better outcome in patients with atrial fibrillation. However, the existing studies have methodological limitations and have, with one exception, not included hemorrhagic strokes. We performed a nationwide historic follow-up study using data from population-based healthcare registries to assess the effect of preadmission OAT on stroke outcomes further. Methods-We identified 11 356 patients with atrial fibrillation admitted to hospital with acute stroke (including ischemic stroke and intracerebral hemorrhage) between 2003 and 2009. Propensity score-matched analyses were used to compare stroke severity (Scandinavian Stroke Scale score) and mortality among 2175 patients with preadmission OAT and 2175 patients without preadmission OAT. Results-A total of 2492 (21.9%) patients received OAT at the time of their stroke. Preadmission OAT was associated with a lower risk of severe stroke (Scandinavian Stroke Scale score at time of admission, <30 point; propensity score-matched odds ratio, 0.74; 95% confidence interval, 0.63-0.86) and lower 30-day mortality rate (propensity score-matched adjusted odds ratio, 0.83; 95% confidence interval, 0.71-0.98). Conclusions-Only