Cheng-Yang Hsieh1, Cheng-Han Lee2, Darren Philbert Wu3, Sheng-Feng Sung4. 1. Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan. 2. Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital and College of Medicine, Tainan, Taiwan. 3. Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan. 4. Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan; Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan. Electronic address: sfsung@cych.org.tw.
Abstract
BACKGROUND: It is unclear whether ischemic stroke patients with known atrial fibrillation (KAF) had different outcomes than those with atrial fibrillation diagnosed after stroke (AFDAS). We aimed to explore the characteristics and outcomes in ischemic stroke patients with KAF or AFDAS. METHODS: Consecutive patients hospitalized between 2000 and 2012 for first-ever stroke along with atrial fibrillation, either diagnosed before or during the stroke hospitalization, were identified from a nationwide claims database in Taiwan. The outcome of interest was a composite outcome of ischemic stroke, intracranial hemorrhage, or death within one year. Univariable and multivariable Cox regression analyses were used to determine the effect of KAF versus AFDAS on the composite outcome. RESULTS: We identified 1161 patients, of whom 481 (41.4%) had KAF and 680 (58.6%) had AFDAS. Age, sex, and stroke severity were similar between groups. However, patients with KAF had a higher prevalence of underlying heart diseases than those with AFDAS (67.2% versus 39.0%, p<0.001). In univariable analysis, patients with KAF had a higher risk of the composite outcome than those with AFDAS (hazard ratio [HR]: 1.42, 95% confidence interval [CI]: 1.13-1.79, p=0.003). In multivariable analysis, KAF was no longer independently associated with the composite outcome. CONCLUSIONS: As compared to ischemic stroke patients with AFDAS, those with KAF had a higher prevalence of underlying heart diseases. Whether AF was known before or diagnosed after stroke was not an independent predictor of the composite outcome.
BACKGROUND: It is unclear whether ischemic strokepatients with known atrial fibrillation (KAF) had different outcomes than those with atrial fibrillation diagnosed after stroke (AFDAS). We aimed to explore the characteristics and outcomes in ischemic strokepatients with KAF or AFDAS. METHODS: Consecutive patients hospitalized between 2000 and 2012 for first-ever stroke along with atrial fibrillation, either diagnosed before or during the stroke hospitalization, were identified from a nationwide claims database in Taiwan. The outcome of interest was a composite outcome of ischemic stroke, intracranial hemorrhage, or death within one year. Univariable and multivariable Cox regression analyses were used to determine the effect of KAF versus AFDAS on the composite outcome. RESULTS: We identified 1161 patients, of whom 481 (41.4%) had KAF and 680 (58.6%) had AFDAS. Age, sex, and stroke severity were similar between groups. However, patients with KAF had a higher prevalence of underlying heart diseases than those with AFDAS (67.2% versus 39.0%, p<0.001). In univariable analysis, patients with KAF had a higher risk of the composite outcome than those with AFDAS (hazard ratio [HR]: 1.42, 95% confidence interval [CI]: 1.13-1.79, p=0.003). In multivariable analysis, KAF was no longer independently associated with the composite outcome. CONCLUSIONS: As compared to ischemic strokepatients with AFDAS, those with KAF had a higher prevalence of underlying heart diseases. Whether AF was known before or diagnosed after stroke was not an independent predictor of the composite outcome.
Authors: David J Seiffge; Gian Marco De Marchis; Masatoshi Koga; Maurizio Paciaroni; Duncan Wilson; Manuel Cappellari; Kosmas Macha Md; Georgios Tsivgoulis; Gareth Ambler; Shoji Arihiro; Leo H Bonati; Bruno Bonetti; Bernd Kallmünzer; Keith W Muir; Paolo Bovi; Henrik Gensicke; Manabu Inoue; Stefan Schwab; Shadi Yaghi; Martin M Brown; Philippe Lyrer; Masahito Takagi; Monica Acciarrese; Hans Rolf Jager; Alexandros A Polymeris; Kazunori Toyoda; Michele Venti; Christopher Traenka; Hiroshi Yamagami; Andrea Alberti; Sohei Yoshimura; Valeria Caso; Stefan T Engelter; David J Werring Journal: Ann Neurol Date: 2020-02-12 Impact factor: 10.422