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Published on: July 20, 2022
Characteristics of Patients With Asymptomatic Atrial Fibrillation and Ischemic Stroke-Insights From the GLORIA-AF
Tobias Heer1, Uwe Zeymer2,3, Christopher J Schwarzbach4
1Department of Cardiology, München Klinik Neuperlach, Academic Teaching Hospital of LMU University of Munich, Munich, Germany.
Insights
Asymptomatic atrial fibrillation (aAF) affects one-third of newly diagnosed AF patients and carries a 2.3-fold stroke risk. Screening high-risk individuals for aAF is crucial for preventing strokes.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Cryptogenic stroke accounts for 20%-30% of ischemic strokes, often linked to undiagnosed atrial fibrillation (AF).
- Early detection of asymptomatic atrial fibrillation (aAF) and anticoagulation can significantly reduce stroke risk.
- Investigating the prevalence of aAF in patients with stroke history or acute stroke is critical for risk stratification.
Purpose of the Study:
- To determine the prevalence of asymptomatic atrial fibrillation (aAF) in patients presenting with stroke.
- To compare the stroke risk associated with aAF versus symptomatic atrial fibrillation (sAF).
- To identify risk factors associated with aAF in stroke patients.
Main Methods:
- Analysis of 15,308 patients with newly diagnosed AF from the GLORIA-AF Registry (November 2011 - December 2014).
- Focus on patients with a history of stroke or acute stroke on admission to assess aAF prevalence.
- Multivariable analysis to identify independent risk factors for stroke in aAF patients.
Main Results:
- Approximately one-third (32%) of patients had aAF, with 12.5% having a history of stroke or acute stroke.
- Patients with aAF had a 2.3-fold higher risk of stroke compared to those with symptomatic AF (sAF).
- Independent stroke risk factors included prior bleeding, chronic kidney disease, and diabetes mellitus.
Conclusions:
- Asymptomatic atrial fibrillation (aAF) is prevalent in about one-third of newly diagnosed AF patients.
- aAF is associated with a significantly increased stroke risk (2.3-fold) compared to sAF.
- Screening for aAF in high-risk stroke patients is recommended to prevent future embolic events.
Background:
Asymptomatic nonvalvular atrial fibrillation is often suspected in patients with cryptogenic stroke which constitute 20%-30% of ischemic strokes. Detection of atrial fibrillation (AF) and treatment with anticoagulation can reduce the risk of stroke. We sought to investigate the prevalence of asymptomatic atrial fibrillation (aAF) in patients with a history of stroke or an acute stroke on admission.
Methods:
From November 2011 until December 2014, 15,308 patients with a first episode of AF were enrolled in phase 2 of the international, prospective, multicenter global registry on long-term oral anticoagulation treatment in patients with AF (GLORIA-AF) Registry. For the present analysis, we focused on patients with aAF regarding the prevalence of stroke.
Results:
One third of patients (n = 4892, 32%) had aAF. Of these, 611 (12.5%) had a history of stroke or an acute stroke on admission. In contrast, 519 of 10,416 (5.0%) patients with symptomatic AF (sAF) had a history of stroke or an acute stroke on admission. Higher age, male gender, permanent AF, stroke, and the combination of stroke, TIA or systemic embolism were associated with a higher prevalence of aAF on admission. In a multivariable analysis, patients with aAF had a 2.3-fold (95% confidence interval (CI), 2.02-2.54) risk for stroke compared to patients with sAF. Other independent risk factors for stroke were a history of prior bleeding (odds ratio 1.62, 95% CI, 1.34-1.92), chronic kidney disease (1.38, 1.21-1.56), and diabetes mellitus (1.24, 1.10-1.41).
Conclusion:
aAF is reported in about one third of patients with newly diagnosed AF and is associated with a 2.3-fold risk for stroke compared to sAF. Therefore, screening for aAF in high-risk patients might be appropriate to prevent further embolic cerebrovascular events.
