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Stroke as the Initial Manifestation of Atrial Fibrillation: The Framingham Heart Study

Steven A Lubitz1, Xiaoyan Yin2, David D McManus2

  • 1From the Cardiovascular Research Center (S.A.L., L.-C.W., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.R.R., P.A.W., S.S., E.J.B.); Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester (D.D.M.); Boston University School of Medicine, MA (H.J.A., J.R.R., P.A.W., S.S., E.J.B.); Department of Neurology, Boston Medical Centre, MA (H.J.A., J.R.R., C.S.K., S.S.); Pulmonary Center and the Section of Pulmonary and Critical Care Medicine, Department of Medicine (A.J.W.) and Preventive Medicine Section, Department of Medicine (E.J.B.), Boston University School of Medicine, MA; and Section of Cardiovascular Medicine and Department of Epidemiology, School of Public Health, Boston University, MA (E.J.B.). slubitz@mgh.harvard.edu.

Stroke
|January 14, 2017
PubMed

Insights

Stroke is an uncommon initial sign of atrial fibrillation (AF). Screening for AF is important, but its cost-effectiveness must consider that stroke is a rare first manifestation of this arrhythmia.

Area of Science:

  • Cardiology
  • Neurology
  • Public Health

Background:

  • Screening for atrial fibrillation (AF) aims to prevent strokes, which can be the first sign of undiagnosed AF.
  • The frequency of stroke as an initial manifestation of AF is not well-established.

Purpose of the Study:

  • To estimate the frequency of stroke as the first presentation of atrial fibrillation (AF).
  • To inform the cost-effectiveness of population-wide AF screening programs.

Main Methods:

  • Analysis of 1809 Framingham Heart Study participants with first-detected AF and no prior strokes.
  • Tabulation of stroke occurrences relative to AF detection (same day, within 30, 90, and 365 days).
  • Estimation of stroke incidence representing initial AF manifestation using reported AF incidence rates.

Main Results:

  • 87 strokes occurred within one year before AF detection.
  • Strokes occurred on the same day as AF detection in 1.7% of cases.
  • Strokes occurred within one year before AF detection in 4.8% of cases.
  • The estimated incidence of stroke as an initial manifestation of AF was 2 to 5 per 10,000 person-years.

Conclusions:

  • Stroke is an uncommon but measurable presenting feature of atrial fibrillation (AF).
  • The relative infrequency of stroke as an initial AF manifestation suggests emphasizing cost-effectiveness in population-wide AF screening is crucial.
Abstract

Keywords:
atrial fibrillationatrial flutterincidencemass screeningstroke

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