What question did this study set out to answer?

This research aims to assess the incidence and predictors of recurrent ischemic stroke in patients with cryptogenic stroke who are later diagnosed with atrial fibrillation.

January 22, 2026Open Access

Incidence and predictors of recurrent stroke in patients with cryptogenic stroke later diagnosed with atrial fibrillation: a 5-year cohort study from a tertiary care hospital

Q: What does this research mean for the field?

Delayed detection of atrial fibrillation and non-adherence to anticoagulation significantly increase the risk of recurrent stroke in patients with cryptogenic stroke. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

SASaad Emhmed AliLady Reading Hospital IUIkram UllahBacha Khan University SSSadiq Ali ShahBacha Khan University

Key Result

Delayed AF detection and non-adherence to anticoagulation significantly increased the risk of recurrent stroke in cryptogenic stroke patients at 3.44 times the baseline risk.

Key Points

This research aims to assess the incidence and predictors of recurrent ischemic stroke in patients with cryptogenic stroke who are later diagnosed with atrial fibrillation.
Conducted as a retrospective cohort study at a tertiary care hospital.
Included adult patients with cryptogenic stroke and subsequent atrial fibrillation diagnosis within 12 months.
Collected data on demographics, diagnostic methods, anticoagulation adherence, and outcomes.
Employed Cox regression to identify independent recurrence predictors.
Out of 406 patients with cryptogenic stroke, 109 (26.8%) were later diagnosed with atrial fibrillation.
Recurrent ischemic stroke occurred in 32 patients (29.4%) over a median follow-up of 13.8 months.
Only 34.4% of recurrent cases were on anticoagulation therapy at recurrence.
Independent predictors of recurrent stroke included age >65 years, delayed AF detection, non-adherence to anticoagulation, and left atrial enlargement.
Mortality (18.8%) and functional disability (59.3% with mRS >3) were higher in the recurrence group.

Structured PICO

What are the incidence and predictors of recurrent ischemic stroke in patients initially diagnosed with cryptogenic stroke and later diagnosed with atrial fibrillation?

Population

109 adult patients initially diagnosed with cryptogenic stroke and subsequently diagnosed with atrial fibrillation within 12 months, at a tertiary care hospital in Pakistan.

Outcome

Recurrent ischemic strokehard clinical

Delayed AF detection and poor anticoagulation adherence significantly increase the risk of recurrent stroke in patients with cryptogenic stroke who are later diagnosed with AF.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Background: Cryptogenic stroke (CS) accounts for a substantial proportion of ischemic strokes, with atrial fibrillation (AF) often identified as the underlying cause. In countries with low-resource settings like Pakistan, limited access to extended cardiac monitoring delays AF detection, increasing the risk of recurrent stroke. Objective: To determine the incidence and predictors of recurrent ischemic stroke in patients initially diagnosed with CS and later diagnosed with AF at a tertiary care hospital in Pakistan. Methods: A retrospective cohort study was conducted at tertiary care Hospital, from January 2018 to December 2023. Adult patients with CS and a subsequent diagnosis of AF within 12 months were included. Data on demographics, diagnostic modality, echocardiography, anticoagulation adherence, and outcomes were collected. Cox regression was used to identify independent predictors of recurrent stroke. Results: Out of 406 patients with CS, 109 (26.8%) were later diagnosed with AF. Recurrent ischemic stroke occurred in 32 patients (29.4%) over a median follow-up of 13.8 months. Only 11 of the recurrent cases (34.4%) were on anticoagulation therapy at the time of recurrence. Multivariate analysis identified age >65 years (HR: 2.21; 95% CI: 1.18–4.14), delayed AF detection beyond 6 months (HR: 2.58; 95% CI: 1.36–4.91), non-adherence to anticoagulation (HR: 3.44; 95% CI: 1.88–6.27), and left atrial enlargement (HR: 2.03; 95% CI: 1.15–3.57) as independent predictors of recurrence. Mortality (18.8%) and functional disability (mRS >3 in 59.3%) were significantly higher in the recurrence group. Conclusion: Delayed AF detection and poor anticoagulation adherence significantly increase the risk of recurrent stroke in CS-AF patients. Prolonged cardiac monitoring and improved access to anticoagulants, particularly NOACs, are essential to reduce recurrent stroke burden in low-resource settings.

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