January 1, 2017Circulation Cardiovascular Quality and Outcomes
Atrial Fibrillation Diagnosis Timing, Ambulatory ECG Monitoring Utilization, and Risk of Recurrent Stroke
Key result
Late atrial fibrillation diagnosis (>7 days post-stroke) without baseline oral anticoagulation was highly associated with recurrent stroke or TIA (HR 2.0; 95% CI 1.9-2.1).
Why the study?
Does late diagnosis of atrial fibrillation (>7 days post-stroke) without baseline oral anticoagulation increase the risk of recurrent stroke or TIA in patients with an index stroke/TIA?
Population
179,160 patients with an index ischemic stroke or transient ischemic attack event recorded between 2008 and…
Comparison
Late diagnosis of atrial fibrillation without… vs Early AF diagnosis or no AF, and/or presence of…
Design
Cohort
Follow-up
1 year
Authors
Discussion
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Member takes
Implication
May support extended post-stroke monitoring; leaves open whether early anticoagulation reduces recurrence in late-diagnosed AF.
Key Points
- This study investigates how the timing of atrial fibrillation diagnosis affects the recurrence risk of ischemic stroke or transient ischemic attack.
- Retrospective cohort study utilizing commercial claims data from 2008 to 2011.
- Included 179,160 patients who experienced an index stroke or TIA, analyzing AF diagnosis timing and ambulatory monitoring.
- Primary outcome measured was the recurrence of ischemic stroke or TIA.
- 10.6% of patients experienced stroke/TIA recurrence within 1 year.
- Patients without oral anticoagulation and with late AF diagnosis (>7 days post-stroke) had a hazard ratio of 2.0 for recurrent stroke/TIA (95% CI, 1.9–2.1).
- Only 2.6% and 9.7% of patients underwent ambulatory ECG monitoring within 7 days and 12 months after stroke, respectively.
Study Design
Type
Cohort (n=179,160)
Structured PICO
Does late diagnosis of atrial fibrillation (>7 days post-stroke) without baseline oral anticoagulation increase the risk of recurrent stroke or TIA in patients with an index stroke/TIA?
P
Population
179,160 patients (mean age 67 years, 53.7% female) with an index stroke or TIA event recorded between 2008 and 2011, followed for at least 1 year.
E
Exposure
Late diagnosis of atrial fibrillation (>7 days post-stroke) without baseline oral anticoagulation
C
Comparator
Early AF diagnosis or no AF, and/or presence of baseline oral anticoagulation
O
Outcome
Recurrence of an ischemic stroke or TIAhard clinical
Main Result
Hazard Ratio: 2 (95% CI 1.9–2.1)
Late diagnosis of atrial fibrillation (>7 days post-stroke) in patients not on baseline oral anticoagulation is associated with a twofold increased risk of recurrent stroke or TIA, highlighting the potential value of early ambulatory ECG monitoring.
Cite This Study
Lip et al. (2017) conducted a cohort in Ischemic stroke or transient ischemic attack (TIA) (n=179,160). Late atrial fibrillation diagnosis (>7 days post-stroke) without baseline oral anticoagulation was evaluated on Recurrence of an ischemic stroke or TIA (HR 2.0, 95% CI 1.9-2.1). Late atrial fibrillation diagnosis (>7 days post-stroke) without baseline oral anticoagulation was highly associated with recurrent stroke or TIA (HR 2.0; 95% CI 1.9-2.1).