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April 9, 2019Stroke

Atrial Fibrillation Known Before or Detected After Stroke Share Similar Risk of Ischemic Stroke Recurrence and Death

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Key result

Atrial fibrillation diagnosed after stroke was associated with a higher risk of 1-year ischemic stroke recurrence compared to sinus rhythm (HR 1.61; 95% CI 1.29-2.01), but similar to known AF.

Why the study?

The study aimed to compare the risk of 1-year ischemic stroke recurrence and death among patients with atrial fibrillation diagnosed after stroke, atrial fibrillation known before stroke, and sinus rhythm.

Does atrial fibrillation diagnosed after stroke (AFDAS) carry a similar risk of 1-year ischemic stroke recurrence and death compared to atrial fibrillation known before stroke (KAF) and sinus rhythm (SR) in patients with acute ischemic stroke?

Population

19 604 patients with acute ischemic stroke admitted to 219 urban hospitals in China

Comparison

AF diagnosed after stroke vs AF known before stroke vs sinus rhythm

Design

Registry-based observational cohort study

Follow-up

1 year

Authors

XYXiaomeng YangChongqing UniversityZRZhenzhen RaoCentral South UniversityHGHongqiu GuUniversity Health Network

Discussion

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Implication

AFDAS may warrant anticoagulation vigilance similar to KAF; registry data leaves open whether detection timing modifies risk or practice.

Study Design

Type

Cohort (n=19,604)

Multicenter

Yes

Structured PICO

Does atrial fibrillation diagnosed after stroke (AFDAS) carry a similar risk of 1-year ischemic stroke recurrence and death compared to atrial fibrillation known before stroke (KAF) and sinus rhythm (SR) in patients with acute ischemic stroke?

P
Population
19,604 patients with acute ischemic stroke admitted to 219 urban hospitals in China, followed for 1 year.
E
Exposure
Atrial fibrillation diagnosed after stroke (AFDAS)
C
Comparator
Atrial fibrillation known before stroke (KAF) and sinus rhythm (SR)
O
Outcome
1-year ischemic stroke recurrence and deathhard clinical

Main Result

Hazard Ratio: 1.61 (95% CI 1.29–2.01)

Absolute Event Rate: 10.9% vs 5.7%

p-value: p=<0.0001

Atrial fibrillation diagnosed after stroke carries a similar risk of 1-year ischemic stroke recurrence and mortality as atrial fibrillation known before stroke, highlighting the need for appropriate treatment in this population.

Cite This Study

Yang et al. (2019) conducted a cohort in acute ischemic stroke (n=19,604). Atrial fibrillation diagnosed after stroke (AFDAS) vs. Sinus rhythm (SR) was evaluated on 1-year ischemic stroke recurrence (HR 1.61, 95% CI 1.29-2.01, p=<0.0001). Atrial fibrillation diagnosed after stroke was associated with a higher risk of 1-year ischemic stroke recurrence compared to sinus rhythm (HR 1.61; 95% CI 1.29-2.01), but similar to known AF.

synapsesocial.com/papers/6a871a24a131ca6707155d97https://doi.org/10.1161/strokeaha.118.024176

Topics

Atrial fibrillationPersistent AF managementAnticoagulation in AFAF ablation outcomes
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Atrial fibrillation as an independent risk factor for stroke: the Framingham Study.1991 · 7,524 citations
  2. 2A Proportional Hazards Model for the Subdistribution of a Competing Risk1999 · 13,956 citations
  3. 3Preexisting Heart Disease Underlies Newly Diagnosed Atrial Fibrillation After Acute Ischemic Stroke2016 · 44 citations
  4. 4Atrial Fibrillation Diagnosis Timing, Ambulatory ECG Monitoring Utilization, and Risk of Recurrent Stroke2017 · 60 citations
  5. 5Insular Cortex Lesions, Cardiac Troponin, and Detection of Previously Unknown Atrial Fibrillation in Acute Ischemic Stroke2015 · 101 citations