Key result
Newly detected atrial fibrillation after ischemic stroke was inversely associated with hypertension (OR 0.37; 95% CI 0.21-0.64, p<0.001) compared to known atrial fibrillation.
Why the study?
AF is frequently diagnosed during acute ischemic stroke and may reflect previously undiagnosed AF, representing a missed opportunity for stroke prevention.
Observational (n=550)
Odds Ratio: 0.37 (95% CI 0.21–0.64)
p-value: p=<0.001
One-third of atrial fibrillation cases in acute ischemic stroke patients are newly diagnosed, representing a missed opportunity for stroke prevention, and these patients present with fewer comorbidities but higher stroke severity.
Hypertension less prevalent in newly detected vs known AF post-stroke; hypothesis-generating for distinct phenotypes and should not yet change practice.
BACKGROUND: Atrial fibrillation (AF) is frequently diagnosed during the acute stage of ischemic stroke (IS), and it may reflect undiagnosed AF before stroke, thus representing a missed opportunity for stroke prevention. This population-based study aimed to assess the prevalence of known AF (KAF) and AF diagnosed early after IS (AFDAS) and to compare clinical and brain/arterial imaging characteristics between patients. METHODS: Among patients with acute IS recorded in the population-based Dijon Stroke Registry, France (2013-2020), we identified those with KAF or AFDAS. AFDAS was considered when AF was diagnosed during the initial work-up based on electrocardiograms, in-hospital continuous electrocardiographic and/or Holter monitoring. Clinical and imaging characteristics on brain CT scan or angio-CT scan when available including old parenchymal lesions, arterial territory of the index IS, and aortic arch, cervical and intracranial arteries atheroma were compared between groups (KAF vs. AFDAS). Regression logistic models were used to assess factors associated with AFDAS (compared to KAF). RESULTS: Among 1,756 IS patients, 550 (31.3%) had AF (mean age: 83.6 ± 10.3 years old, 60.5% women), of whom 367 (66.7%) presented with KAF and 183 (33.3%) had AFDAS. In multivariable model, hypertension (OR = 0.37; 95% CI: 0.21-0.64, p < 0.001), chronic heart failure (OR = 0.34; 95% CI: 0.18-0.67, p = 0.002), previous stroke (OR = 0.42; 95% CI: 0.26-0.67, p < 0.001), and preexisting dementia (OR = 0.36; 95% CI: 0.21-0.63, p < 0.001) were inversely associated with AFDAS, whereas NIHSS score was associated with AFDAS (OR = 1.02; 95% CI: 1.00-1.05, p = 0.012). CONCLUSIONS: Our findings indicate a more advanced stage of the atrial cardiomyopathy in KAF as compared with AFDAS patients and may thus contribute to the fact that in these latter patients AF had not been diagnosed prior to stroke. This group of patients undeniably represents a missed opportunity for stroke prevention.
No takes yet. Share an insight, caveat, or question.
Mitaine et al. (2024) conducted an observational in Acute ischemic stroke and atrial fibrillation (n=550). Newly detected atrial fibrillation after ischemic stroke (AFDAS) vs. Known atrial fibrillation (KAF) was evaluated on Association of hypertension with AFDAS (vs KAF) (OR 0.37, 95% CI 0.21-0.64, p=<0.001). Newly detected atrial fibrillation after ischemic stroke was inversely associated with hypertension (OR 0.37; 95% CI 0.21-0.64, p<0.001) compared to known atrial fibrillation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: