Stroke as the Initial Manifestation of Atrial Fibrillation

Study Questions:

How frequently do patients with atrial fibrillation (AF) present with stroke as the initial manifestation?

Methods:

Using the Framingham Heart Study, the authors identified participants with first-detected AF and no prior stroke. They then examined how many patients reported a stroke on the same day as AF detection, as well as within 30, 90, and 365 days prior to AF detection. They then used previously reported AF incidence rates to estimate the incidence of stroke that may represent an initial manifestation of AF.

Results:

Among 1,809 community-dwelling participants, 87 strokes were observed within 1 year of AF detection: 1.7% occurred on the same day as AF detection, 3.4% within 30 days, 3.7% within 90 days, and 4.8% within 1 year of AF detection. The estimated incidence of stroke as initial AF manifestation is 2-5 per 10,000 person-years, in both men and women.

Conclusions:

The authors concluded that stroke is an uncommon, but measurable presenting feature of AF. The authors also concluded that their data suggest that emphasizing cost-effectiveness and population-wide AF screening efforts could improve population-level stroke rates.

Perspective:

The authors outline the potential impact of undiagnosed AF on population rates of stroke. While most patients with AF-related strokes occur in patients with a known AF diagnosis, a small but significant proportion present with stroke and no prior AF diagnosis. Multiple attempts at population-level screening for AF have previously been reported, including the use of traditional methods (e.g., blood pressure cuff, heart rate monitors, and electrocardiography machines) as well as newer, tech-driven devices (e.g., mobile phone-based tools). While cost-effectiveness of these interventions remains largely untested, clinicians should have a heightened awareness to potentially screen patients for occult AF.

Clinical Topics: Arrhythmias and Clinical EP, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Blood Pressure, Brain Ischemia, Cost-Benefit Analysis, Electrocardiography, Incidence, Secondary Prevention, Stroke, Vascular Diseases


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