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Atrial fibrillation in patients with first-ever stroke: frequency, antithrombotic treatment before the event and
M Paciaroni1, G Agnelli, V Caso
1Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy. mpaciaroni@libero.it
Insights
Atrial fibrillation (AF) significantly increases stroke risk and adverse outcomes. Inadequate antithrombotic treatment in AF patients before stroke is common, highlighting a critical gap in stroke prevention and management.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Atrial fibrillation (AF) is a major independent risk factor for ischemic stroke.
- Effective management of AF is crucial for stroke prevention and improving patient outcomes.
Purpose of the Study:
- To determine the frequency of known and unknown AF in first-ever ischemic stroke patients.
- To assess the association between AF and adverse outcomes (death or disability) at discharge.
- To evaluate antithrombotic agent use, guideline adherence, and their impact on outcomes in AF patients.
Main Methods:
- Inclusion of consecutive patients admitted with acute first-ever stroke to a Stroke Unit.
- Performance of 12-lead electrocardiogram (ECG) on admission for AF detection.
- Assessment of functional outcome at discharge using the modified Rankin Score.
Main Results:
- Atrial fibrillation (known or newly diagnosed) was identified in 20.3% of patients.
- AF presence was significantly correlated with increased mortality or disability at discharge (OR = 1.58).
- Only 10% of patients with known AF received adequate antithrombotic treatment prior to stroke, with suboptimal adherence to guidelines.
Conclusions:
- Atrial fibrillation is highly prevalent in first-ever stroke patients and associated with poorer outcomes.
- Current antithrombotic treatment adherence in AF patients is alarmingly low, indicating a need for improved stroke prevention strategies.
- Inadequate treatment for AF patients contributes to adverse outcomes, emphasizing the importance of guideline adherence.
Background And Purposes:
Atrial fibrillation (AF) is an independent risk factor for stroke. The aims of this study were to assess: (i) the frequency of known or unknown AF in patients admitted to the hospital for a first-ever ischemic stroke and whether AF is associated with an adverse outcome at discharge (death or disability); (ii) the rates and determinants for the use of antithrombotic agents before stroke in patients with known AF and the adherence to the current treatment guidelines; and (iii) whether the lack of adherence to the current guidelines is associated with adverse outcome at discharge.
Methods:
Consecutive patients with acute first-ever stroke admitted to an individual Stroke Unit between January 2000 to December 2003, were included in the study. Twelve-lead electrocardiogram (ECG) was performed in all patients on admission. Functional outcome was measured at discharge according to modified Rankin Score.
Results:
A total of 1549 patients were included in the study: 238 patients (15.4%) were known to have AF and 76 (4.9%) were diagnosed with AF (unknown) on ECG performed on admission. At discharge 91 patients (5.9%) had died and 605 patients (39.0%) had died or were functionally dependent. Multivariate analysis showed that AF on admission was correlated with mortality or disability (OR = 1.58, 95% CI 1.09-2.30, P = 0.015). Before stroke, 124 out of 238 patients with known AF (52.1%) were not on antithrombotic therapy, 83 (34.9%) were receiving antiplatelet and 31 (13.0%) anticoagulant treatment. Previous transient ischemic attack, history of ischemic heart disease and hyperlipidemia were associated with the use of antithrombotic therapy. Only 24 out of 114 patients on antithrombotic treatment on admission were adequately treated according to the current guidelines. Of the adequately treated patients, 41.7% died or were disabled at discharge respect to 52.3% of the patients non-adequately treated (RR = 0.80, 95% CI 0.48-1.30).
Conclusions:
AF (on history or new diagnosis) was present in 20.3% of the patients with first-ever stroke admitted to a Stroke Unit and it was associated with increased mortality or disability. Only 10% of patients with known AF were previously receiving an adequate antithrombotic treatment according to current guidelines.
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