Stroke Severity and Outcomes in Patients With Newly Diagnosed Atrial Fibrillation

Abstract

Background and Purpose: Once a stroke occurs in a patient with atrial fibrillation (AF), it is likely to be severe. Patients with newly diagnosed AF after stroke and those with known AF before stroke have different background characteristics, yet the difference in stroke severity has not been sufficiently evaluated. In the current study, we compared the stroke severity and in-hospital outcomes between these patient groups.Methods: We retrospectively analyzed a database of 196 patients with acute ischemic stroke and AF between January 2010 and October 2019. We divided the patients into two groups: patients with “newly diagnosed AF” and those with “known AF.” We assessed the stroke severity using the National Institutes of Health Stroke Scale (NIHSS) score on admission and in-hospital outcomes using the modified Rankin Scale (mRS) score at discharge.Results: The proportion of newly diagnosed AF was 33% (64/196). There were no differences in age, hypertension, diabetes mellitus, and past history of heart failure between patients with newly diagnosed AF and those with known AF. Patients with newly diagnosed AF were associated with a lower proportion of male sex (male; 50 vs. 67%, p < 0.05), a lower proportion of past history of stroke (12 vs. 35%, p < 0.01), a lower CHA2DS2-VASc score (median [interquartile range]; 3 [2–4] vs. 3.5 [3–5], p < 0.01), and a lower proportion of pre-stroke oral anticoagulation (5 vs. 59%, p < 0.01). There were no differences in the NIHSS score on admission (12 [4–19] vs. 9 [3–19]) or the mRS score at discharge (3 [1–5] vs. 3 [1–5]). After adjustment for relevant covariates, newly diagnosed AF was not associated with the NIHSS score on admission [adjusted common odds ratio (OR), 0.85; 95% confidence interval (CI), 0.45–1.60] or the mRS score at discharge (adjusted common OR, 1.67; 95% CI, 0.88–3.18). After propensity score matching, newly diagnosed AF was not associated with the NIHSS score on admission (adjusted common OR, 0.91; 95% CI, 0.48–1.73) and the mRS score at discharge (adjusted common OR, 1.77; 95% CI, 0.92–3.43).Conclusion: Stroke severity and in-hospital outcomes in patients with newly diagnosed AF did not differ from those in patients with known AF after adjustment for clinically relevant factors. The importance of detection of latent AF and subsequent anticoagulation in preventing severe stroke should be further emphasized.

Differences between Atrial Fibrillation Detected before and after Stroke and TIA: A Systematic Review and Meta-Analysis

“…Main characteristics of included studies[3,9,10,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] Online supplementary TableS6(online suppl. material) summarizes the demographic characteristics and baseline risk factors of patients included in all studies.…”

Sinus rhythm restoration and improved outcomes in patients with acute ischemic stroke and in-hospital paroxysmal atrial fibrillation

“…25 "Neurogenic" PAF may serve as a potential explanation of the lower or similar risk of stroke recurrence compared to patients with known AF. 1,7,13 In our study PAF was detected in most of the cases during the first days of hospitalization and taking into account that later PAF detection was associated with higher risk of recurrent stroke and MACE, we cannot exclude the possibility that episodes especially early after the index event may be related to the index stroke. This finding supports the notion of the stroke-related heart syndrome, although without providing any evidence on the potentially "benign" nature of these episodes.…”

“…Although several observational studies have shown that post-stroke AF did not affect the risk of stroke recurrence compared to those with known AF, 12,13 others showed that post-stroke AF was related to higher risk of recurrent stroke and mortality on follow-up compared to those with known AF. 6 A nationwide cohort analysis found that early initiation of rhythm control was associated with a lower risk of adverse cardiovascular outcomes, compared to rate control amongst patients with recently diagnosed AF.…”

Association between Rapid Ventricular Response and Stroke Outcomes in Atrial Fibrillation-Related Cardiac Embolic Stroke

“…END was defined as a total NIHSS score of ≥2 or motor NIHSS score of ≥1 within the first 72 h of admission [11]. Functional outcome at 3 months after discharge was measured using the modified Rankin scale (mRS) and was categorized as good (0-2) or poor (3)(4)(5)(6) by a stroke neurologist, either during the patients' physical visits to our clinic or by telephone. The mortality rate within 3 months was also assessed.…”

“…This may be associated with a larger infarction volume due to a sudden occlusion of blood flow by a clot from the heart without sufficient time for compensation by collateral circulation [3]. AF patients with concomitant cardiac problems show more severe strokes [4].…”