Ischemic Stroke Severity and Mortality in Patients With and Without Atrial Fibrillation

Abstract

Background Our objective was to investigate stroke severity and subsequent rate of mortality among patients with and without atrial fibrillation (AF). Contemporary data on stroke severity and prognosis in patients with AF are lacking. Methods and Results First‐time ischemic stroke patients from the Danish Stroke Registry (January 2005–December 2016) were included in an observational study. Patients with AF were matched 1:1 by sex, age, calendar year, and CHA 2 DS 2 ‐VASc score with patients without AF. Stroke severity was determined by the Scandinavian Stroke Scale (0–58 points). The rate of death was estimated by Kaplan‐Meier plots and multivariable Cox regression. Among 86 458 identified patients with stroke, 17 205 had AF. After matching, 14 662 patients with AF and 14 662 patients without AF were included (51.8% women; median age, 79.6 years [25th–75th percentile, 71.8–86.0]). More patients with AF had very severe stroke (0–14 points) than patients without AF (13.7% versus 7.9%, P <0.01). The absolute rates of 30‐day and 1‐year mortality were significantly higher for patients with AF (12.1% and 28.4%, respectively) versus patients without AF (8.7% and 21.8%, respectively). This held true in adjusted models for 30‐day mortality (hazard ratio [HR], 1.40 [95% CI, 1.30–1.51]). However, this association became nonsignificant when additionally adjusting for stroke severity (HR, 1.10 [95% CI, 1.00–1.23]). AF was associated with a higher rate of 1‐year mortality (HR, 1.39 [95% CI, 1.32–1.46]), although it was mediated by stroke severity (HR, 1.15 [95% CI, 1.09–1.23], model including stroke severity). Conclusions In a contemporary nationwide cohort of patients with ischemic stroke, patients with AF had more severe strokes and higher mortality than patients without AF. The difference in mortality was mainly driven by stroke severity.

Long-Term Outcomes after Stroke in Patients with Atrial Fibrillation: A Single Center Study

“…In our study, patients in the AF group were older than those in the SR group. Among patients with AF, those over 74 years of age accounted for the largest proportion, which is similar to the results of other studies [ 16 , 17 , 18 , 19 ].…”

“…The findings from previous studies have shown that AF is associated with a worse prognosis in patients with ischemic stroke, but the research mainly assessed short-term mortality and reports of stroke recurrence in patients with coexisting AF are rare [ 13 , 14 , 15 , 16 ].…”

Factors associated with favorable outcomes in acute severe stroke patients: A real‑world, national database study

“…Additionally, patients with atrial fibrillation have a higher risk of thrombogenicity associated with larger thrombus formation ( 16 ), diminished cerebral autoregulation resulting in cerebral dysfunction after stroke ( 17 ), poor collateral circulation due to chronic hypoperfusion from cervical atherosclerosis ( 18 , 19 ), and no recanalization after thrombolytic therapy, as old and large thrombi in the left atrium are more resistant to thrombolysis ( 20 ). However, the Danish Stroke Registry found atrial fibrillation was associated with a higher rate of mortality, which is primarily driven by worse stroke severity and not atrial fibrillation itself ( 21 ). On the other hand, the present study found atrial fibrillation was still associated with higher odds of worse outcomes after adjustment for severity of stroke.…”

“…Data used in this study was obtained from between October 2015 and September 2018. The inclusion criteria were: >18 years or older, diagnosed with acute severe ischemic stroke (defined by an admission NIHSS score of [15][16][17][18][19][20][21][22][23][24], and available stroke outcome data. Patients with incomplete data were excluded.…”

Outcomes in patients with ischaemic stroke undergoing endovascular thrombectomy: Impact of atrial fibrillation

“…middle cerebral artery) resulting in major ischaemic regions, which together with the impaired collateral flow seen in patients with AF, may lead to serious disability and death. 2,3 Endovascular thrombectomy (EVT) has been shown to improve clinical outcomes such as functional independence, successful reperfusion, ICH, and mortality in patients with ischaemic stroke. 4 Furthermore, the evidence derived from observational studies that investigated the effect of AF on people following an ischaemic stroke who underwent EVT has been inconsistent.…”