Clinical characteristics and risk factors of atrial fibrillation detection after acute ischemic stroke

The atrial fibrillation detected after stroke (AFDAS) confers an elevated risk of unfavorable outcomes for acute ischemic stroke (AIS) patients, necessitating early identification of high-risk patients.

This study was a secondary analysis of data from the prospective, multicenter China National Stroke Registry II (CNSR-II). AFDAS was defined as a new atrial fibrillation episode (> 30 s) detected after the onset of AIS. Patients who had AFDAS but without prior atrial fibrillation history were included in this study. Multivariable logistic regression was used to identify risk factors linked to AFDAS. All patients were followed for 1 year to assess stroke recurrence. And then we explored the relationship between AFDAS and ischemic stroke recurrence by using multivariable logistic regression analysis.

Among 23,446 patients, 572 (2.4%) developed AFDAS. These patients were older and had more severe neurological deficits on admission than those who remained in sinus rhythm. Independent risk factors for AFDAS included older age (≥ 65 years: OR = 2.14, 95% CI: 1.44-3.16), history of coronary arterial disease (OR = 1.88, 95% CI: 1.22-2.92), elevated C-reactive protein (OR = 1.02, 95% CI: 1.01-1.02), and lower triglyceride levels (OR = 0.76, 95% CI: 0.61-0.96). During a 1-year follow-up, recurrent stroke occurred in 1,467 patients (6.3%). The recurrence rate was significantly higher in the AFDAS group than in the SR group (11.7% vs. 6.1%, P < 0.001). AFDAS was more prevalent in patients with recurrence (4.6% vs. 2.3%, P < 0.001) and remained an independent risk factor for 1-year stroke recurrence after adjusting for traditional risk factors (OR = 1.82, P < 0.001).

Older age, coronary heart disease history, and inflammatory marker (CRP) may assist in early identification of AFDAS, a condition associated with significantly increased stroke recurrence risk. Targeted monitoring and secondary prevention strategies are warranted, especially for AFDAS patients with prior cerebrovascular or cardiac comorbidities.