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Published on: February 26, 2013
Patients With Ischemic Stroke and Incident Atrial Fibrillation: A Nationwide Cohort Study
Laurent Fauchier1, Nicolas Clementy2, Christele Pelade2
1From the Service de Cardiologie, Pôle Cœur Thorax Vasculaire, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France (L.F., N.C.); Medtronic France, Boulogne-Billancourt, France (C.P., C.C.); Medtronic Europe, Tolochenaz, Switzerland (E.N.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.). lfau@med.univ-tours.fr.
Insights
Patients with ischemic stroke face a higher risk of developing atrial fibrillation (AF). Risk scores like CHADS2 and CHA2DS2-VASc help identify those most vulnerable to new-onset AF after stroke.
Area of Science:
- Cardiology
- Neurology
- Epidemiology
Background:
- Atrial fibrillation (AF) is a significant contributor to ischemic stroke incidence.
- Patients experiencing ischemic stroke without diagnosed AF may have an elevated risk of future AF diagnosis.
- This risk is often linked to the presence of various cardiovascular risk factors.
Purpose of the Study:
- To investigate the hypothesis that patients with ischemic stroke without prior AF diagnosis have a higher risk of subsequent AF diagnosis.
- To identify risk factors associated with new-onset AF in post-ischemic stroke patients.
Main Methods:
- A longitudinal cohort study utilizing a French national hospital care database (2008-2012).
- Analysis included 48,992 patients with ischemic stroke in 2009 who did not have AF at baseline.
- Follow-up duration averaged 15 months, assessing new AF diagnoses.
Main Results:
- The incidence rate of new-onset AF was 7.9 per 100 person-years among ischemic stroke patients without prior AF.
- CHADS2 and CHA2DS2-VASc scores were significantly associated with increased risk of new-onset AF.
- Independent predictors included age (65-74 and ≥75 years), hypertension, heart failure, and vascular disease.
Conclusions:
- Ischemic stroke is associated with a substantially increased risk of incident AF.
- Higher CHADS2 or CHA2DS2-VASc scores identify patients at greater risk for new-onset AF post-stroke.
- These risk scores serve as practical tools for risk stratification in this patient population.
Background And Purpose:
A substantial part of ischemic strokes is attributed to atrial fibrillation (AF). We hypothesized that patients with ischemic stroke without prior diagnosed AF were at higher risk of having a subsequent diagnosis of AF, and this was associated with multiple risk factors.
Methods:
This French longitudinal cohort study was based on the national database covering hospital care from 2008 to 2012 for the entire population.
Results:
Of 65 807 patients with ischemic stroke in 2009, 48 992 did not have AF at baseline. A total of 4828 of these patients were diagnosed as having AF during a follow-up of 15±15 months (incidence rate 7.9 per 100 person-years). By comparison, the yearly rate of new-onset AF for the 826 416 patients with a cardiac hospitalization was 5.9%. CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack) and CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack [doubled], vascular disease, age 65-75 years, and sex category [female]) scores were both associated with the risk of new-onset AF during follow-up (CHADS2: hazard ratio [HR] 1.70, 95% confidence interval [CI] 1.66-1.75; CHA2DS2-VASc: HR 1.45, 95% CI 1.42-1.48). The c statistics were 0.700 (95% CI 0.696-0.706) for CHADS2 and 0.706 (95% CI 0.702-0.710) with CHA2DS2-VASc (P=0.003 for comparison of the 2 scores). Independent predictors of subsequent diagnosis of AF were age 65 to 74 years (HR 2.29, 95% CI 2.06-2.54), age ≥75 years (HR 3.31, 95% CI 3.02-3.64), hypertension (HR 1.22, 95% CI 1.13-1.32), heart failure (HR 2.56, 95% CI 2.41-2.72), and vascular disease (HR 1.10, 95% CI 1.04-1.17).
Conclusions:
Ischemic stroke was associated with a substantially increased risk of incident AF, particularly among individuals with higher CHADS2 or CHA2DS2-VASc scores. These risk scores seem to be simple tools for identifying patients at higher risk of incident AF after ischemic stroke.
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