Patients With Ischemic Stroke and Incident Atrial Fibrillation. Issue 9 (September 2015)

• Record Type: Journal Article
• Authors: Fauchier, Laurent; Clementy, Nicolas; Pelade, Christele; Collignon, Cecile; Nicolle, Emmanuelle; Lip, Gregory Y.H.
• Is Part Of: Stroke. Volume 46:Issue 9(2015)
• Publication Date: 2015-09
• Subjects: Cerebrovascular disease -- Periodicals; Cerebral circulation -- Periodicals; 616.81
• DOI: 10.1161/STROKEAHA.115.010270
• Languages: English
• ISSNs: 0039-2499

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background and Purpose—</title> <p>A substantial part of ischemic strokes is attributed to atrial fibrillation (AF). We hypothesized that patients with ischemic stroke without prior diagnosed AF were at higher risk of having a subsequent diagnosis of AF, and this was associated with multiple risk factors.</p> </sec> <sec> <title>Methods—</title> <p>This French longitudinal cohort study was based on the national database covering hospital care from 2008 to 2012 for the entire population.</p> </sec> <sec> <title>Results—</title> <p>Of 65 807 patients with ischemic stroke in 2009, 48 992 did not have AF at baseline. A total of 4828 of these patients were diagnosed as having AF during a follow-up of 15±15 months (incidence rate 7.9 per 100 person-years). By comparison, the yearly rate of new-onset AF for the 826 416 patients with a cardiac hospitalization was 5.9%. CHADS<sub>2</sub> (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack) and CHA<sub>2</sub>DS<sub>2</sub>-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack [doubled], vascular disease, age 65–75 years, and sex category [female]) scores were both associated with the risk of new-onset AF during follow-up (CHADS<sub>2</sub>: hazard ratio [HR] 1.70, 95% confidence interval [CI] 1.66–1.75; CHA<sub>2</sub>DS<sub>2</sub>-VASc: HR 1.45, 95% CI 1.42–1.48). The c statistics were 0.700 (95% CI 0.696–0.706) for CHADS<sub>2</sub> and 0.706 (95% CI 0.702–0.710) with CHA<sub>2</sub>DS<sub>2</sub>-VASc (<italic>P</italic>=0.003 for comparison of the 2 scores). Independent predictors of subsequent diagnosis of AF were age 65 to 74 years (HR 2.29, 95% CI 2.06–2.54), age ≥75 years (HR 3.31, 95% CI 3.02–3.64), hypertension (HR 1.22, 95% CI 1.13–1.32), heart failure (HR 2.56, 95% CI 2.41–2.72), and vascular disease (HR 1.10, 95% CI 1.04–1.17).</p> </sec> <sec> <title>Conclusions—</title> <p>Ischemic stroke was associated with a substantially increased risk of incident AF, particularly among individuals with higher CHADS<sub>2</sub> or CHA<sub>2</sub>DS<sub>2</sub>-VASc scores. These risk scores seem to be simple tools for identifying patients at higher risk of incident AF after ischemic stroke.</p> </sec> </abstract>