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Published on: February 26, 2013
Risk Factors and Outcomes Associated with Atrial Fibrillation Detected after Intracerebral Hemorrhage
Farid Khasiyev1,2, Karin Oh1, Angela Velazquez1
1Department of Neurology, Columbia University Irving Medical Center, 177 Fort Washington Ave., New York, NY, 10032, USA.
Insights
Atrial fibrillation detected after stroke (AFDAS) in intracerebral hemorrhage (ICH) patients is linked to worse long-term outcomes, despite fewer baseline cardiovascular issues. Early detection and prevention strategies are needed.
Area of Science:
- Neurology
- Cardiology
- Clinical Research
Background:
- Atrial fibrillation detected after stroke (AFDAS) is common after ischemic stroke but poorly understood in intracerebral hemorrhage (ICH).
- Investigating AFDAS in ICH is crucial for understanding its occurrence and clinical impact.
- This study characterizes risk factors and long-term outcomes associated with AFDAS in ICH patients.
Purpose of the Study:
- To determine the incidence and risk factors of AFDAS in patients with spontaneous ICH.
- To evaluate the association between AFDAS and long-term outcomes in ICH survivors.
- To compare clinical characteristics and comorbidities between ICH patients with AFDAS, known AF, and sinus rhythm.
Main Methods:
- Retrospective analysis of 532 consecutive spontaneous ICH patients from 2009-2018 with continuous cardiac monitoring.
- Patients classified into sinus rhythm (SR), AFDAS (AF detected during index ICH hospitalization), and known AF groups.
- Primary outcome: poor modified Rankin scale (mRS 4-6) at 3 months; multivariable logistic regression used for analysis.
Main Results:
- AFDAS occurred in 5% of ICH patients, typically by hospital day 3.
- AFDAS patients had fewer baseline cardiovascular comorbidities but higher rates of infectious complications during hospitalization.
- Poor 3-month outcomes were significantly more common in AFDAS patients (94%) compared to known AF (78%) and SR (65%) groups.
- AFDAS was independently associated with poor long-term outcomes (aOR 11.07, 95% CI 1.30-94.27).
Conclusions:
- ICH patients with AFDAS exhibit a distinct profile with fewer baseline cardiovascular comorbidities but worse long-term prognoses.
- Further research is needed to elucidate the drivers of AFDAS and its direct link to poor ICH outcomes.
- Prospective studies are essential to confirm findings and explore the potential benefits of AFDAS detection and prevention in improving ICH outcomes.
Background:
Atrial fibrillation detected after stroke (AFDAS) refers to newly identified atrial fibrillation occurring after an index cerebrovascular event, most commonly ischemic stroke, but little is known about its occurrence and clinical implications in patients with spontaneous intracerebral hemorrhage (ICH). We aimed to characterize AFDAS risk factors in ICH and AFDAS' relationship with long-term ICH outcomes.
Methods:
We retrospectively analyzed consecutively admitted and enrolled patients with spontaneous ICH to a single tertiary comprehensive stroke center between 2009 and 2018 who underwent continuous cardiac monitoring. Patients were categorized as having sinus rhythm [SR (reference)], atrial fibrillation detected after stroke (AFDAS, defined here as atrial fibrillation (AF) detected during the index ICH hospitalization), and known AF. Demographic, clinical, imaging, and hospitalization complication data were compared across rhythm groups. Poor modified Rankin scale (mRS 4-6) at 3-month follow-up was assessed as the primary clinical outcome. Multivariable logistic regression assessed independent relationships of AFDAS with poor outcomes adjusting for demographics, ICH severity, and AFDAS risk factors.
Results:
Amongst 532 patients with ICH, AFDAS occurred in 5% on median ICH hospital day 3. Outside of increased hypertension prevalence, patients with AFDAS had fewer baseline cardiovascular comorbidities compared with patients with known AF yet had similar cardiac risk profiles and structural/function measurements on echocardiogram compared with patients with SR. Baseline ICH characteristics and severity were similar between groups, but patients with AFDAS were more likely to have hospitalization infection complications (67% vs. 32% in known AF, 42% in SR, p = 0.01). Poor 3-month outcome was more common in patients with AFDAS (94%) compared with those with known AF (78%) and sinus rhythm (65%) (p = 0.01), and AFDAS was independently associated with poor outcomes [adjusted odds ratio (OR) 11.07, 95% confidence interval (CI) 1.30-94.27].
Conclusions:
We identified that patients with ICH and AFDAS have less severe cardiovascular comorbidities yet are more likely to have worse long-term outcomes. Further prospective studies are required to confirm these results and characterize drivers for AFDAS development and links between AFDAS and poor ICH outcomes to assess whether AFDAS detection and prevention can improve ICH.
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