Potential missed opportunities to prevent ischaemic stroke: prospective multicentre cohort study of atrial fibrillation-associated ischaemic stroke and TIA. Issue 7 (24th July 2019)

• Record Type: Journal Article
• Authors: Wilson, Duncan; Ambler, Gareth; Shakeshaft, Clare; Banerjee, Gargi; Charidimou, Andreas; Seiffge, David; White, Mark; Cohen, Hannah; Yousry, Tarek; Salman, Rustam; Lip, Gregory Y H; Muir, Keith; Brown, Martin M; Jäger, H R; Werring, David J
• Other Names: author non-byline.; Harkness Kirsty author non-byline.; Shaw Louise author non-byline.; Sword Jane author non-byline.; Nor Azlisham Mohd author non-byline.; Sharma Pankaj author non-byline.; Veltkamp Roland author non-byline.; Kelly Deborah author non-byline.; Harrington Frances author non-byline.; Randall Marc author non-byline.; Smith Matthew author non-byline.; Mahawish Karim author non-byline.; Elmarim Abduelbaset author non-byline.; Esisi Bernard author non-byline.; Cullen Claire author non-byline.; Nallasivam Arumug author non-byline.; Price Christopher author non-byline.; Barry Adrian author non-byline.; Roffe Christine author non-byline.; Coyle John author non-byline.; Hassan Ahamad author non-byline.; Lovelock Caroline author non-byline.; Birns Jonathan author non-byline.; Cohen David author non-byline.; Sekaran L author non-byline.; Parry-Jones Adrian author non-byline.; Parry Anthea author non-byline.; Hargroves David author non-byline.; Proschel Harald author non-byline.; Datta Prabel author non-byline.; Darawil Khaled author non-byline.; Manoj Aravindakshan author non-byline.; Burn Mathew author non-byline.; Patterson Chris author non-byline.; Giallombardo Elio author non-byline.; Smyth Nigel author non-byline.; Mansoor Syed author non-byline.; Anwar Ijaz author non-byline.; Marsh Rachel author non-byline.; Ispoglou Sissi author non-byline.; Chadha Dinesh author non-byline.; Prabhakaran Mathuri author non-byline.; Meenakishundaram Sanjeevikumar author non-byline.; O'Connell Janice author non-byline.; Scott Jon author non-byline.; Krishnamurthy Vinodh author non-byline.; Aghoram Prasanna author non-byline.; Mccormick Michael author non-byline.; Paul O'Mahony Nikola Sprigg author non-byline.; Cooper Martin author non-byline.; Choy Lillian author non-byline.; Wilkinson Peter author non-byline.; Leach Simon author non-byline.; Caine Sarah author non-byline.; Burger Ilse author non-byline.; Gunathilagan Gunaratam author non-byline.; Guyler Paul author non-byline.; Emsley Hedley author non-byline.; Davis Michelle author non-byline.; Manawadu Dulka author non-byline.; Pasco Kath author non-byline.; Mamun Maam author non-byline.; Luder Robert author non-byline.; Sajid Mahmud author non-byline.; Anwar Ijaz author non-byline.; Okwera James author non-byline.; Staals Julie author non-byline.; Warburton Elizabeth author non-byline.; Saastamoinen Kari author non-byline.; England Timothy author non-byline.; Putterill Janet author non-byline.; Flossman Enrico author non-byline.; Power Michael author non-byline.; Dani Krishna author non-byline.; Mangion David author non-byline.; Suman Appu author non-byline.; Corrigan John author non-byline.; Lawrence Enas author non-byline.; Vahidassr Djamil author non-byline.;
• Is Part Of: BMJ open. Volume 9:Issue 7(2019)
• Publication Date: 2019-07-24
• Subjects: atrial fibrillation -- stroke -- anticoagulation; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2018-028387
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : 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 CHA2 DS2 -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 CHA2 DS2 -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). CHA2 DS2 -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 .