Karsten Keller1, Lukas Hobohm2, Philip Wenzel3, Thomas Münzel4, Christine Espinola-Klein5, Mir A Ostad5. 1. Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany. Electronic address: Karsten.Keller@unimedizin-mainz.de. 2. Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany. 3. Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany. 4. Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany. 5. Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
Abstract
BACKGROUND: Stroke is the second leading cause of death worldwide. Ischemic strokes, which are caused by atrial fibrillation/flutter (AF), may be more devastating than those that occur without AF. OBJECTIVE: The purpose of this study was to investigate the impact of AF on adverse events in hospitalized ischemic stroke patients and to estimate the elevated impact of AF on the occurrence of these adverse events. METHODS: The nationwide German inpatient sample of the years 2005-2015 was used for this analysis. Ischemic stroke patients were identified by ICD code I63 and stratified by AF. Logistic regression models were used to investigate the impact of AF on adverse in-hospital events and adjusted for age, sex, and comorbidities to prove the independence of the associations. RESULTS: Overall, 2,958,697 hospitalized ischemic stroke patients (50.5% female, 65.4% age >70 years) were included in the analysis. Of these patients, 849,466 (28.7%) were diagnosed with AF. Overall, 9.0% of the stroke patients died in-hospital. The case fatality rate increased with age and was higher in stroke patients with AF than in those without AF (13.0% vs 7.3%; P <.001). AF was an important predictor of in-hospital death (odds ratio 1.30; 95% confidence interval 1.28-1.31; P <.001) and adverse events during hospitalization, independent of age, sex, and comorbidities. Deterioration of patient prognosis due to AF was especially pronounced in younger patients. CONCLUSION: AF in ischemic stroke patients is associated with higher in-hospital mortality and higher rate of adverse events during hospitalization, independent of age, sex, and comorbidities.
BACKGROUND:Stroke is the second leading cause of death worldwide. Ischemic strokes, which are caused by atrial fibrillation/flutter (AF), may be more devastating than those that occur without AF. OBJECTIVE: The purpose of this study was to investigate the impact of AF on adverse events in hospitalized ischemic strokepatients and to estimate the elevated impact of AF on the occurrence of these adverse events. METHODS: The nationwide German inpatient sample of the years 2005-2015 was used for this analysis. Ischemic strokepatients were identified by ICD code I63 and stratified by AF. Logistic regression models were used to investigate the impact of AF on adverse in-hospital events and adjusted for age, sex, and comorbidities to prove the independence of the associations. RESULTS: Overall, 2,958,697 hospitalized ischemic strokepatients (50.5% female, 65.4% age >70 years) were included in the analysis. Of these patients, 849,466 (28.7%) were diagnosed with AF. Overall, 9.0% of the strokepatients died in-hospital. The case fatality rate increased with age and was higher in strokepatients with AF than in those without AF (13.0% vs 7.3%; P <.001). AF was an important predictor of in-hospital death (odds ratio 1.30; 95% confidence interval 1.28-1.31; P <.001) and adverse events during hospitalization, independent of age, sex, and comorbidities. Deterioration of patient prognosis due to AF was especially pronounced in younger patients. CONCLUSION:AF in ischemic strokepatients is associated with higher in-hospital mortality and higher rate of adverse events during hospitalization, independent of age, sex, and comorbidities.