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Updated: May 3, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Long-term survival after ischemic stroke in patients with atrial fibrillation
Margaret C Fang1, Alan S Go, Yuchiao Chang
1From the Departments of Medicine (M.C.F., A.S.G.) and Epidemiology & Biostatistics (A.S.G.), University of California, San Francisco; Division of Research (A.S.G., N.K.P., N.U.), Kaiser Permanente of Northern California, Oakland; and Clinical Epidemiology Unit (Y.C., L.H.B., D.E.S.), General Medicine Division, Massachusetts General Hospital, Boston.
Insights
Atrial fibrillation-related stroke triples mortality risk in patients, with long-term survival significantly impacted by stroke severity. Stroke prevention offers greater survival benefits than typically recognized.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- The short-term effects of atrial fibrillation (AF)-related stroke are well-documented.
- Long-term survival outcomes following AF-related stroke remain understudied.
Purpose of the Study:
- To investigate the long-term impact of ischemic stroke on survival in patients with atrial fibrillation.
- To assess the association between stroke severity and long-term mortality.
Main Methods:
- A cohort of 13,559 patients with atrial fibrillation was followed for a median of 6 years.
- Ischemic strokes were identified and validated; stroke severity was assessed.
- Survival rates of stroke patients were compared to matched non-stroke patients using proportional hazard models.
Main Results:
- Median survival after stroke was 1.8 years versus 5.7 years for non-stroke comparators (HR 2.8).
- Increased mortality risk persisted long-term (HR 2.0 for those surviving 6 months post-stroke).
- Mortality risk significantly correlated with stroke severity (HR 2.9 for major deficits, HR 8.3 for severe deficits).
Conclusions:
- Ischemic stroke approximately triples the mortality rate in atrial fibrillation patients.
- The detrimental effect on survival extends beyond the acute phase and is linked to disability.
- Anticoagulation for stroke prevention provides substantial survival benefits beyond immediate post-stroke outcomes.
Objectives:
While the short-term impact of atrial fibrillation-related stroke has been well studied, surprisingly little is known about its long-term effect on survival.
Methods:
We followed 13,559 patients with atrial fibrillation for a median of 6 years, identifying ischemic strokes through computerized databases and validating 1,025 events. Stroke severity was determined from hospital records. We compared survival of stroke patients with comparator nonstroke patients (matched for age, sex, race, comorbid conditions, and time of entry into the cohort) using proportional hazard models controlling for warfarin use and compared survival by degree of discharge deficit.
Results:
Median survival after stroke was 1.8 years compared with 5.7 years for matched nonstroke comparators (hazard ratio [HR] 2.8, 95% confidence interval [CI] 2.5-3.2). This increased risk of all-cause death persisted even after restricting the analysis to the 576 stroke patients who survived 6 months after the initial stroke event (HR 2.0, 95% CI 1.7-2.5, adjusting for warfarin use). Risk of death was strongly associated with stroke severity: HR 2.9 (95% CI 2.3-3.5) for strokes resulting in major deficits and HR 8.3 (95% CI 5.2-13.2) for strokes resulting in severe deficits compared with matched comparators without stroke.
Conclusions:
Ischemic stroke approximately triples the mortality rate in patients with atrial fibrillation. This effect persists well beyond the immediate period poststroke and is strongly associated with disability after stroke. Stroke prevention by anticoagulation has even greater beneficial effects on survival than usually considered when focusing solely on 30-day mortality rates.
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