Key result
Known AF links to ~9% fewer recurrent strokes but higher mortality than newly diagnosed AF.
Why the study?
Clinical characteristics and long-term outcomes of ischemic stroke patients with newly diagnosed AF after stroke were not clearly established, with prior studies limited by low anticoagulant prescription and short follow-up.
Does newly diagnosed atrial fibrillation after ischemic stroke carry a different risk of recurrent stroke and mortality compared to known atrial fibrillation, and does anticoagulant therapy improve these outcomes?
Cohort (n=158,909)
Yes
Does newly diagnosed atrial fibrillation after ischemic stroke carry a different risk of recurrent stroke and mortality compared to known atrial fibrillation, and does anticoagulant therapy improve these outcomes?
Patients with newly diagnosed AF after ischemic stroke have higher risks of recurrent ischemic and hemorrhagic stroke but lower all-cause mortality compared to those with known AF, and anticoagulant therapy significantly reduces these risks.
Answers are grounded in this paper and cite their sources.
Known AF associated with lower recurrent stroke but higher mortality than new AF post-stroke; leaves open whether diagnosis timing should guide anticoagulation.
BACKGROUND The clinical characteristics and long-term outcomes of patients with ischemic stroke (IS) and newly diagnosed atrial fibrillation after stroke (NAF) have not been clearly established. Previous studies evaluating patients with NAF were limited by the low prescription rates of anticoagulants and short follow-up periods. METHODS Consecutive patients hospitalized for IS between 2014 and 2017 were identified from a National Health Insurance Research Database. The included patients were categorized into three groups: (1) known diagnosis of AF (KAF) before the index stroke, (2) NAF, and (3) without AF (non-AF). Univariable and multivariable Cox regression analyses were performed to estimate the hazard ratio (HR) for independent variables and recurrent IS, hemorrhagic stroke, or death. RESULTS We identified 158,909 patients with IS of whom 16,699 (10.5%) had KAF and 7,826 (4.9%) had NAF. The patients with NAF were younger, more often male, and had lower CHA 2 DS 2 -VASc scores (3.8 ± 1.9 versus 4.9 ± 1.8, p < 0.001) than the patients with KAF. Anticoagulant treatment significantly reduced the risks of all outcomes. Compared with NAF, KAF was associated with lower risks of recurrent IS [hazard ratio (HR): 0.91, 95% confidence interval (CI): 0.86–0.97, p < 0.01] and hemorrhagic stroke (HR: 0.88, 95% CI: 0.79–0.99, p < 0.01) and a higher risk of all-cause mortality (HR: 1.11, 95% CI: 1.07–1.16, p < 0.001). The risks of all three outcomes were significantly higher for both NAF and KAF than for non-AF. CONCLUSIONS The risks of recurrent IS and hemorrhagic stroke were higher and of all-cause mortality was lower for patients with NAF than with KAF. Anticoagulant therapy significantly reduced the risks of recurrent IS, hemorrhagic stroke, and all-cause mortality.
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Chang et al. (2023) conducted a cohort in Ischemic stroke with atrial fibrillation (n=158,909). Known atrial fibrillation (KAF) vs. Newly diagnosed atrial fibrillation (NAF) was evaluated on Recurrent ischemic stroke (HR 0.91, 95% CI 0.86-0.97, p=<0.01). Compared with newly diagnosed atrial fibrillation, known atrial fibrillation in ischemic stroke patients was associated with a lower risk of recurrent ischemic stroke (HR 0.91) but a higher risk of all-cause mortality (HR 1.11).
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