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Atrial Fibrillation After Stroke
Study Questions:
What is the incidence of atrial fibrillation (AF) after an ischemic stroke?
Methods:
This was a retrospective, longitudinal cohort study based on analysis of a national hospital database in France. A total of 48,992 patients with an ischemic stroke and no prior diagnosis of AF were identified. CHA2DS2-VASc scores were calculated for all patients. A group of 826,416 patients with a cardiac hospitalization served as a control group.
Results:
Newly diagnosed AF was identified in 4,828 patients during a mean follow-up of 15 months, yielding an annual incidence of 7.9% after an ischemic stroke. The annual incidence of newly diagnosed AF was lower (5.95%) in the control group. The CHA2DS2-VASc score was associated with a risk of incident AF. The independent predictors of incident AF after an ischemic stroke were age 65-74 years (hazard ratio [HR], 2.29), age ≥75 years (HR, 3.31), hypertension (HR, 1.22), heart failure (HR, 2.56), and vascular disease (HR, 1.10).
Conclusions:
Ischemic stroke is associated with a higher risk of developing AF during follow-up, particularly in older patients with hypertension, heart failure, or vascular disease.
Perspective:
The causes of the ischemic strokes were not reported in this study, and it is possible that subclinical AF that had not yet been diagnosed caused some of the strokes. The results of the study emphasize the importance of intense monitoring for AF in patients who have had a cryptogenic stroke and of awareness of the higher risk of incident AF in the overall population of patients with an ischemic stroke.
Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Heart Failure, Hypertension, Risk, Stroke, Vascular Diseases
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