Stepwise Screening of Atrial Fibrillation in a 75-Year-Old Population

Engdahl, Johan; Andersson, Lisbeth; Mirskaya, Maria; Rosenqvist, Mårten

doi:10.1161/circulationaha.112.126656

Cited by 209 publications

(169 citation statements)

References 45 publications

Supporting

Mentioning

147

Contrasting

Unclassified

Order By: Relevance

“…In a recent screening study of 75-and 76-year-old individuals in the general population using prolonged intermittent ECG monitoring, 49% more AF was found than had previously been known (increase from 9.6% to 14.3%). 9 The true prevalence of AF among patients with ischemic stroke is, therefore, probably higher than our estimates. The likelihood for AF among patients with stroke was directly correlated with the CHA 2 DS 2 -VASc score.…”

Section: Discussioncontrasting

confidence: 56%

“…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. A recent meta-analysis of 5038 patients in 32 studies reported that, on average, 11% of patients with ischemic stroke have newly detected AF when examined by cardiac rhythm monitoring.…”

mentioning

confidence: 99%

See 1 more Smart Citation

High Prevalence of Atrial Fibrillation Among Patients With Ischemic Stroke

Friberg

Rosenqvist

Lindgren³

et al. 2014

Stroke

Self Cite

281

133

View full text Add to dashboard Cite

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.)

show abstract

Section: Discussioncontrasting

confidence: 56%

mentioning

confidence: 99%

High Prevalence of Atrial Fibrillation Among Patients With Ischemic Stroke

Friberg

Rosenqvist

Lindgren³

et al. 2014

Stroke

Self Cite

281

133

View full text Add to dashboard Cite

show abstract

“…In that study on subjects aged 75 to 76 years with at least 2 risk factors for stroke according to CHADS 2 in a small Swedish community, the baseline prevalence was 9.6%, which increased to 14% after 2 weeks of handheld ECG recording for 20 to 30 seconds twice a day plus at palpitations. 20 In our study, some patients with asymptomatic AF have probably been diagnosed when seeing their physicians for different other complaints, but there is likely a substantial number of asymptomatic and undiagnosed individuals with AF in the VG Region.…”

Section: Discussionmentioning

confidence: 72%

Atrial Fibrillation, Stroke Risk, and Warfarin Therapy Revisited

Björck¹,

Palaszewski

Friberg

et al. 2013

Stroke

303

208

View full text Add to dashboard Cite

Background and Purpose— Atrial fibrillation (AF) is a major risk factor for ischemic stroke. This study aims to update the knowledge about AF and associated stroke risk and benefits of anticoagulation. Methods— We extracted data from the hospital, specialized outpatient, and primary healthcare and drug registries in a Swedish region with 1.56 million residents. We identified all individuals who had received an AF diagnosis during the previous 5 years; all stroke events during 2010; and patients with AF aged ≥50 years who had received warfarin during 2009. Results— AF had been diagnosed in 38 446 subjects who were alive at the beginning of 2010 (prevalence of 3.2% in the adult [≥20 years] population); ≈46% received warfarin therapy. In 2010, there were 4565 ischemic stroke events and 861 intracranial hemorrhages. AF had been diagnosed in 38% of ischemic events (≥50% among those aged ≥80 years) and in 23% of intracranial hemorrhages. An AF diagnosis was often lacking in hospital discharge records after stroke events. Warfarin therapy was associated with an odds ratio of 0.50 (confidence interval, 0.43–0.57) for ischemic stroke and, despite an increased risk of intracranial hemorrhage, an odds ratio of 0.57 (confidence interval, 0.50–0.64) for the overall risk for stroke. Conclusions— AF is more common than present guidelines suggest. The attributable risk of AF for ischemic stroke increases with age and is close to that of hypertension in individuals aged ≥80 years. Because a majority of patients with AF with increased risk for stroke had not received anticoagulation therapy, there is a large potential for improvement.

show abstract

“…Powtarzana codzienna rejestracja EKG zwiększała szansę wykrycia niemego klinicznie, bezobjawowego napadowego AF w nieselekcjonowanej szwedzkiej populacji osób w wieku > 75 lat [120,135]. Kilka urządzeń obsługiwanych przez pacjenta [136,137] oraz przedłużone ciągłe monitorowanie EKG za pomocą rejestratorów z elektrodą przyklejaną do skóry [138] uzyskały walidację jako metody wykrywania napadowego AF (dodatkowa ryc.…”

Section: Długotrwałe Monitorowanie W Celu Wykrywania Napadowego Migotunclassified