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Mortality in acute stroke with atrial fibrillation. The Italian Acute Stroke Study Group
L Candelise1, G Pinardi, A Morabito
1Istituto di Clinica Neurologica, Università degli Studi di Milano, Italy.
Insights
Atrial fibrillation significantly increases mortality risk in acute stroke patients. This condition, associated with older age and severe deficits, doubles the risk of death within six months.
Area of Science:
- Neurology
- Cardiology
- Public Health
Background:
- Atrial fibrillation (AF) is a common arrhythmia.
- The impact of AF on acute ischemic stroke outcomes requires further elucidation.
Purpose of the Study:
- To compare mortality rates and prognostic factors in acute ischemic stroke patients with and without atrial fibrillation.
Main Methods:
- Retrospective comparison of 211 patients with acute ischemic stroke and AF versus 837 patients without AF.
- Analysis of demographic data, clinical characteristics, computed tomography findings, and vital signs.
- Calculation of case-fatality rates at 1 and 6 months, and relative risk adjusted for prognostic factors.
Main Results:
- The AF group had higher frequencies of women, older age, severe neurologic deficits, abnormal CT scans, and elevated heart rate.
- 1-month case-fatality rates were 27% (AF) vs. 14% (no AF); 6-month rates were 40% (AF) vs. 20% (no AF).
- AF was a significant independent predictor of mortality at 1 month (RR=1.55) and 6 months (RR=1.74).
Conclusions:
- Atrial fibrillation is a negative prognostic factor in acute ischemic stroke, significantly increasing mortality.
- Cerebral embolism alone does not fully account for the increased mortality; other pathogenetic mechanisms are implicated.
- Further research into associated mechanisms is warranted to improve outcomes for stroke patients with AF.
Abstract:
We compared 211 consecutive patients who had acute ischemic hemispheric stroke and atrial fibrillation with 837 consecutive patients who had stroke without atrial fibrillation. The atrial fibrillation group included a higher frequency of women, older subjects, and those with a severe neurologic deficit, abnormal computed tomogram, and elevated heart rate. The 1-month case-fatality rate in the atrial fibrillation group was 27% while that in the group without atrial fibrillation was 14%. The 6-month case-fatality rates in the two groups were 40% and 20%, respectively. The risk of death attributable to atrial fibrillation, adjusted for the effect of other prognostic factors, was significant at 1 month (relative risk = 1.55) and at 6 months (relative risk = 1.74). The causes of death were equally distributed in the two groups during both the acute and subacute phases. We conclude that atrial fibrillation is a negative prognostic factor in patients hospitalized for acute stroke. Nevertheless, cerebral embolism alone does not completely explain the increase in mortality for stroke patients with atrial fibrillation. Other associated pathogenetic mechanisms must also be taken into account.