Key result
Advanced age, female gender, CHF, and high NIHSS predict a ~64% risk of post-stroke pAF.
Why the study?
The incidence of paroxysmal atrial fibrillation in ischemic stroke or transient ischemic attack patients and the clinical predictors for new pAF diagnosis were not well described.
What are the clinical predictors of new-onset paroxysmal atrial fibrillation in patients with ischemic stroke or TIA?
Observational (n=1,240)
What are the clinical predictors of new-onset paroxysmal atrial fibrillation in patients with ischemic stroke or TIA?
A clinical risk prediction model incorporating age, female gender, heart failure history, and stroke severity can help identify ischemic stroke or TIA patients at high risk for underlying paroxysmal atrial fibrillation.
May guide selective post-stroke monitoring; hypothesis-generating and requires prospective validation before practice change.
INTRODUCTION: The aims of this study are to describe the incidence of paroxysmal atrial fibrillation (pAF) in patients with ischemic stroke (IS) or transient ischemic attack (TIA), and to create a risk prediction model, using immediately available clinical data associated with new pAF diagnosis. METHODS: We analyzed data from the BASICMAR stroke register, with 5 inclusion criteria: (1) diagnosis of IS/TIA; (2) no history of AF or structural cardiopathy; (3) stroke unit (SU) monitoring after normal electrocardiogram in the emergency room; (4) complete etiologic study; and (5) 3-month follow-up. We investigated clinical predictors of pAF detection; we analyzed newly diagnosed pAF according to 4 cardiac monitoring screening methods and created a pAF-risk prediction model. RESULTS: The final cohort included 1,240 patients. pAF was diagnosed in 139 patients (11.2%), the majority at the SU (54.7%). Multivariate predictors of new-pAF diagnosis during 3-month follow-up after ischemic event were age 75 years, female gender, history of congestive heart failure, and initial National Institute of Health Stroke Scale 15, with a predicted AF risk of 64%. CONCLUSIONS: This risk prediction model can be helpful to estimate the risk of an underlying pAF within 3 months after suffering an IS/TIA, contributing to increased AF detection efforts, thereby starting the correct secondary prevention treatment.
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Giralt‐Steinhauer et al. (2015) conducted an observational in Ischemic stroke (IS) or transient ischemic attack (TIA) (n=1,240). Clinical predictors (age 75, female gender, history of congestive heart failure, initial NIHSS 15) was evaluated on New-onset paroxysmal atrial fibrillation (pAF) diagnosis. New-onset paroxysmal atrial fibrillation was diagnosed in 11.2% of ischemic stroke or TIA patients within 3 months, with age 75, female gender, CHF, and NIHSS 15 predicting a 64% risk.
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