August 28, 2024Journal of Atherosclerosis and ThrombosisOpen Access

Severity, Outcomes, and their Secular Changes in 33,870 Ischemic Stroke Patients with Atrial Fibrillation in a Hospital-Based Registry: Japan Stroke Data Bank

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Why the study?

The study aimed to determine the severity, functional outcomes, and secular changes in acute atrial fibrillation-associated stroke patients.

Does the presence of atrial fibrillation affect initial severity, functional outcomes, and their secular changes in acute ischemic stroke patients?

Structured PICO

Does the presence of atrial fibrillation affect initial severity, functional outcomes, and their secular changes in acute ischemic stroke patients?

Population

142,351 acute ischemic stroke patients (33,870 with atrial fibrillation) from a hospital-based, multicenter, prospective registry in Japan (January 2000 through December 2020).

Intervention

Presence of atrial fibrillation (AF)

Comparator

Absence of atrial fibrillation (non-AF)

Outcome

Co-primary outcomes: initial severity assessed by the NIH Stroke Scale (NIHSS) score and favorable outcome assessed by the modified Rankin Scale scores 0-2 at hospital dischargehard clinical

Over a 21-year period, initial stroke severity became milder and functional outcomes improved more steeply in patients with atrial fibrillation compared to those without, likely reflecting advances in stroke care.

Implication

AF stroke severity and outcomes improved more than non-AF over 21 years; extends observational evidence of care advances benefiting this subgroup.

Abstract

AIM: Severity, functional outcomes, and their secular changes in acute atrial fibrillation (AF)-associated stroke patients were determined. METHODS: Acute ischemic stroke patients with AF in a hospital-based, multicenter, prospective registry from January-2000 through December-2020, were compared with those without AF. The co-primary outcomes were the initial severity assessed by the NIH Stroke Scale (NIHSS) score and favorable outcome assessed by the modified Rankin Scale scores 0-2 at hospital discharge. RESULTS: Of the 142,351 patients studied, 33,870 had AF. AF patients had higher NIHSS scores (median 9 vs. 3, adjusted coefficient 5.468, 95% CI 5.354-5.582) than non-AF patients. Favorable outcome was less common in AF patients than in non-AF patients in the unadjusted analysis (48.4% vs. 70.4%), but it was more common with adjustment for the NIHSS score and other factors (adjusted OR 1.110, 95% CI 1.061-1.161). In AF patients, the NIHSS score decreased throughout the 21-year period (adjusted coefficient -0.088, 95% CI -0.115 - -0.061 per year), and the reduction was steeper than in non-AF patients (P＜0.001). In AF patients, favorable outcome became more common over the period (adjusted OR 1.018, 95% CI 1.010-1.026), and the increase was steeper than in non-AF patients (P＜0.001); the increase was no longer significant after further adjustment by reperfusion therapy. CONCLUSIONS: Initial stroke severity became milder and functional outcomes improved in AF patients over the 21-year period. These secular changes were steeper than in non-AF patients, suggesting that AF-associated stroke seemed to reap more benefit of recent development of stroke care than stroke without AF.