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Stroke severity in atrial fibrillation. The Framingham Study
H J Lin1, P A Wolf, M Kelly-Hayes
1Department of Neurology, Boston University School of Medicine, MA 02118, USA.
Stroke
|October 1, 1996
Summary
Atrial fibrillation (AF) stroke is nearly twice as fatal as non-AF stroke, with higher recurrence and severe functional deficits. Early prevention of AF-related stroke is critical for reducing mortality and disability.
Area of Science:
- Cardiology
- Neurology
- Epidemiology
Background:
- Clinical series suggest stroke with atrial fibrillation (AF) is more severe.
- Prospective epidemiological data on AF-related stroke outcomes are limited and inconsistent.
Purpose of the Study:
- To investigate the long-term impact of atrial fibrillation on stroke severity and outcomes.
- To compare mortality and functional status of ischemic stroke in patients with and without AF.
Main Methods:
- Analysis of over 40-year follow-up data from the Framingham cohort (5070 participants).
- Evaluation of 501 initial ischemic strokes, including 103 with AF, assessing severity and 30-day mortality.
- Functional status assessed using the Barthel index since 1981 for acute and 12-month follow-up.
Main Results:
- AF was linked to increased stroke severity (P = .048) and higher 30-day mortality (25% vs. 14%).
- Multivariate analysis showed an 84% increased odds of 30-day mortality for AF-related strokes (OR, 1.84).
- AF stroke survivors experienced poorer survival, more recurrences, and significantly lower Barthel index scores up to 12 months post-stroke.
Conclusions:
- Ischemic stroke in patients with AF is nearly twice as likely to be fatal compared to non-AF stroke.
- AF is associated with increased stroke recurrence and more severe functional deficits in survivors.
- Given that stroke is often the initial embolic event in AF, preventive strategies are crucial to mitigate disability and mortality.