Association between Prediabetes and Stroke in Hospitalized GeriatricPatients with Atrial Fibrillation: A Contemporary Population-BasedAnalysis

Background: The association of prediabetes (pDM) with stroke risk in non-diabetic geriatric patients with AF is unclear. This analysis examined the relationship among pDM, AF, and stroke, highlighting the need for targeted interventions and risk management in this population. Methods: We identified all non-diabetic geriatric admissions with AF using the 2019 National Inpatient Sample and ICD-10-CM coding. Patients were categorized into pDM+ and pDMgroups. The primary outcomes were stroke incidence and sex disparities in stroke risk. Results: Among 218,130 geriatric AF admissions, 3,525(1.6%) had pDM. The pDM+ cohort was younger (median 75 vs 77 years), and had higher rates of hypertension (50.2 vs 43.6%), hyperlipidemia (66.4 vs 53.7%), obesity (30.2 vs 13.6%), and peripheral vascular disease (15.3 vs 9.9%). Adjusting for baseline characteristics, stroke risk was higher in the pDM+ cohort (1.4% vs. 0.8%, OR 2.00, 95% CI 1.06-3.77; p=0.033). In subgroup analyses, males showed a stronger association (OR 5.48, 95% CI 1.43-21.02; p=0.013). Discussion: pDM exists as an underrecognized stroke risk factor in elderly patients with AF. Male patients showed a stronger association between pDM and stroke, warranting additional investigation to understand underlying biological and clinical contributors. Identifying pDM enables earlier detection of vulnerable patients and developing preventive strategies. Incorporating pDM into risk models could improve patient risk assessment and support individualized treatment planning Conclusion: Conclusion: Geriatric patients hospitalized with AF and concomitant pDM had approximately twofold higher odds of in-hospital stroke, with a male preponderance. These findings support early identification of pDM in AF patients to enable the development of tailored interventions that mitigate stroke risk.