Key result
Known AF precedes stroke or TIA in ~32% of unanticoagulated patients despite strong anticoagulation indications.
Why the study?
The study investigated the proportion of patients with known AF, and differences compared to newly diagnosed AF, among patients presenting with ischaemic stroke or TIA not previously treated with anticoagulation.
Cohort (n=1,470)
Yes
Approximately one-third of patients presenting with AF-associated stroke without prior anticoagulation had previously known AF, representing a significant missed opportunity for stroke prevention.
Suggests gaps in anticoagulation for known AF; leaves open whether targeted interventions reduce stroke incidence in observational cohorts.
Objective We report on: (1) the proportion of patients with known atrial fibrillation (AF); and (2) demographic, clinical or radiological differences between patients with known AF (and not treated) and patients with newly diagnosed AF, in a cohort of patients who presented with ischaemic stroke or transient ischaemic attack (TIA) not previously treated with anticoagulation. Design We reviewed cross-sectional baseline demographic and clinical data from a prospective observational cohort study, (CROMIS-2). Setting Patients were recruited from 79 hospital stroke centres throughout the UK and one centre in the Netherlands. Participants Patients were eligible if they were adults who presented with ischaemic stroke or TIA and AF and had not been previously treated with oral anticoagulation. Main outcome measures Proportion of patients with known AF before index ischaemic stroke or TIA from a cohort of patients who have not been previously treated with oral anticoagulation. Secondary analysis includes the comparison of CHA 2 DS 2 -VASc and HAS-BLED scores and other demographics and risk factors between those with newly diagnosed AF and those with previously known AF. Results Of 1470 patients included in the analysis (mean age 76 years (SD 10)), 622 (42%) were female; 999 (68%) patients had newly diagnosed AF and 471 (32%) patients had known AF. Of the 471 patients with known AF, 68% had a strong indication for anticoagulation and 89% should have been considered for anticoagulation based upon CHA 2 DS 2 -VASc score. Patients with known AF were more likely to have a prior history of dementia (4% vs 2%, p=0.02) and had higher HAS-BLED scores (median 3 vs 2). CHA 2 DS 2 -VASc, other risk factors and demographics were similar. Conclusions About 1/3 of patients who present with stroke and have AF who have not been treated with oral anticoagulation have previously known AF. Of these patients, at least 68% were not adequately treated with oral anticoagulation. Trial registration number NCT02513316 .
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Wilson et al. (2019) conducted a cohort in Ischaemic stroke or transient ischaemic attack (TIA) and atrial fibrillation (n=1,470). Known atrial fibrillation vs. Newly diagnosed atrial fibrillation was evaluated on Proportion of patients with known AF before index ischaemic stroke or TIA from a cohort of patients who have not been previously treated with oral anticoagulation. Previously known atrial fibrillation was present in 32% of patients presenting with stroke or TIA without prior anticoagulation, of whom 68% had a strong indication for anticoagulation.
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