January 1, 2011Cerebrovascular Diseases

Characteristics, Treatment and Outcome of Ischemic Stroke with Atrial Fibrillation in a Chinese Hospital-Based Stroke Study

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Why the study?

Does atrial fibrillation increase death and disability in patients with first-ever ischemic stroke?

Structured PICO

Does atrial fibrillation increase death and disability in patients with first-ever ischemic stroke?

Population

2,683 first-ever ischemic stroke patients admitted within 1 month of stroke onset

Intervention

Presence of atrial fibrillation (n=366)

Comparator

Absence of atrial fibrillation (n=2,317)

Outcome

3-month, 6-month and 1-year death and disability (modified Rankin Scale score 3-5)hard clinical

Ischemic stroke patients with atrial fibrillation experience significantly higher mortality, disability, and complication rates compared to those without AF, highlighting the severe impact of AF and the underuse of oral anticoagulants in this population.

Implication

AF marks higher post-stroke mortality and disability; extends observational data but leaves open whether anticoagulation modifies prognosis.

Abstract

BACKGROUND: There is scant information on characteristics, treatment, functional outcome and case fatality of ischemic stroke with atrial fibrillation (AF) in China. METHODS: For this study, first-ever ischemic stroke patients who were admitted within 1 month of stroke onset during the period of March 2002 through December 2008 were included. Data on ischemic stroke patients were collected which included: demographics, risk factors, treatment administered, stroke-related complications and 3-month, 6-month and 1-year death and disability. Multivariate regression models were used to analyze predictors for death and disability. RESULTS: Of the 2,683 patients included in this study, 366 (13.6%) had AF. In this group, valvular AF was observed in 153 (41.8%) patients. Compared to patients without AF, patients with AF were older (66.1 vs. 63.6, p = 0.001) and had a higher NIHSS score on admission (median 10 vs. 4, p < 0.001) and more frequently suffered from hemorrhagic transformation (7.3 vs. 2.8%, p < 0.001), pulmonary infection (27 vs. 10.6%, p < 0.001), urinary tract infection (8.5 vs. 3.0%, p < 0.001), acute gastrointestinal tract hemorrhage (4.1 vs. 1.9%, p = 0.008), electrolyte disturbance (5.2 vs. 1.8%, p < 0.001), acute renal failure (1.1 vs. 0.5%, p = 0.005) and urinary incontinence (3.8 vs. 0.6%, p < 0.001) during hospitalization. The percentages of patients with AF who received oral anticoagulants were 3.3% before stroke onset and 14.2% at discharge. Moreover, patients with AF had a higher proportion of disability (determined as modified Rankin Scale score 3-5) in 3-month, 6-month and 1-year follow-ups (46.6, 41.9 and 37.6 vs. 29.1, 24.0 and 19.3%, respectively, p < 0.001) and higher case fatality in hospitalization, 3-month, 6-month and 1-year follow-ups (10.1, 25.5, 29.1 and 34.0 vs. 2.0, 7.4, 8.8 and 11.6%, respectively, p < 0.001). Multivariate logistic regression determined that AF, age and NIHSS score were the independent predictors for the 3-month, 6-month and 1-year death. CONCLUSIONS: Ischemic stroke patients with AF have a poorer outcome, a higher frequency of stroke-related complications and a higher case fatality than patients without AF. Oral anticoagulants were underused in AF patients.