Why the study?
The relation between AF and stroke care outcomes across diverse populations is understudied, particularly regarding sex and race-ethnic disparities.
Does the presence of atrial fibrillation worsen hospital stroke outcomes and are there sex and race-ethnic disparities in patients with ischemic stroke?
Does the presence of atrial fibrillation worsen hospital stroke outcomes and are there sex and race-ethnic disparities in patients with ischemic stroke?
In patients with ischemic stroke, the presence of atrial fibrillation is associated with worse hospital outcomes, including greater disability, lower rates of discharge to home, and prolonged hospital stays, with notable sex and racial/ethnic disparities.
AF signals higher-risk ischemic stroke hospitalizations; leaves open whether targeted therapies or disparity reduction improve outcomes.
BACKGROUND AND PURPOSE: Atrial Fibrillation (AF) is the most common cardiac cause of ischemic stroke. However, the relation between AF and stroke care outcomes in diverse populations is understudied. We aimed to evaluate sex and race-ethnic disparities associated with AF in hospital stroke outcomes utilizing data from the FLorida PuErto Rico Atrial Fibrillation (FLiPER-AF) Stroke Study. METHODS: The study included 104,308 ischemic stroke cases with available information on AF status enrolled in a state-wide stroke registry from 2010 to 2016. Multivariable logistic regression models were performed to evaluate the association between AF and stroke outcomes and the modification effects on the associations by sex and by race-ethnicity, adjusted for socio-demographic status, vascular risk factors and stroke severity. RESULTS: AF was present in 23% of ischemic stroke cases. AF was associated with worse disability at discharge (OR=1.11, 95% CI, 1.04-1.18), less discharge to home (OR=0.89, 0.85-0.92), and longer length of hospital stay (LOS>6 days, OR=1.53, 1.46-1.60). Interaction analyses showed that the association between AF and less discharge to home was stronger in women than men (p for interaction <0.001), as well as in FL-whites than in FL-blacks, FL-Hispanics or PR-Hispanics (p for interaction=0.002). The association between AF and prolonged LOS was more prominent in PR-Hispanics than in FL-blacks, FL-Hispanics, or FL-whites (p for interaction <0.001). From 2010 to 2016, the effects of AF on hospital length of stay attenuated (p for interaction<0.001). CONCLUSIONS: AF was associated with poor disability at discharge, less discharge to home, and prolonged hospital length of stay for acute stroke care. The effect of AF on length of stay attenuated over time. Sex and race-ethnic disparities were observed in the effect of AF on being less discharge to home and prolonged hospital stay. Further research is needed to identify and modify the biologic and systems of care contributors to these disparities.
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Dong et al. (2019) studied this question.
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