Atrial fibrillation is not uncommon among patients with ischemic stroke and transient ischemic stroke in China

Abstract

BackgroundAtrial fibrillation (AF) is reported to be a less frequent cause of ischemic stroke in China than in Europe and North America, but it is not clear whether this is due to underestimation. Our aim was to define the true frequency of AF-associated stroke, to determine the yield of 6-day Holter ECG to detect AF in Chinese stroke patients, and to elucidate predictors of newly detected AF.MethodsPatients with acute ischemic stroke or transient ischemic attack (TIA) were enrolled in a prospective, multicenter cohort study of 6-day Holter monitoring within 7 days after stroke onset at 20 sites in China between 2013 and 2015. Independent predictors of newly-detected AF were determined by multivariate analysis.ResultsAmong 1511 patients with ischemic stroke and TIA (mean age 63 years, 33.1% women), 305 (20.2%) had either previously known (196, 13.0%) or AF newly-detected by electrocardiography (53, 3.5%) or by 6-day Holter monitoring (56/1262, 4.4%). A history of heart failure (OR = 4.70, 95%CI, 1.64–13.5), advanced age (OR = 1.06, 95%CI, 1.04–1.09), NIHSS at admission (OR = 1.06, 95%CI, 1.02–1.10), blood high density lipoprotein (HDL) (OR = 1.52, 95%CI, 1.09–2.13), together with blood triglycerides (OR = 0.64, 95%CI, 0.45–0.91) were independently associated with newly-detected AF.ConclusionsContrary to previous reports, AF-associated stroke is frequent (20%) in China if systemically sought. Prolonged noninvasive cardiac rhythm monitoring importantly increases AF detection in patients with recent ischemic stroke and TIA in China. Advanced age, history of heart failure, and higher admission NIHSS and higher level of HDL were independent indicators of newly-detected AF.Trial registration NCT02156765 (June 5, 2014).

Prior Antithrombotic Therapy is Associated with Increased Risk of Death in Patients with Intracerebral Hemorrhage: Findings from the Chinese Stroke Center Alliance (CSCA) Study

“…The percentage of prior OAs use in this study was lower than a recent cohort study [ 14 ]. The underuse of warfarin [ 19 ]could be related to the underestimate of the risk of atrial fibrillation[ 20 ] and cost of oral non-vitamin K antagonists.…”

A Stroke Risk Detection: Improving Hybrid Feature Selection Method

“…The detection model included demographics, medical history, anthropometrics, and conventional risk factors. However, the Framingham model overestimates the risk of stroke in China because of obvious differences in the disease spectrum and risk factors [17,18]. A joint Chinese-American research group constructed a risk detection model of ischemic stroke and hemorrhagic stroke with 6 risk factors, including systolic blood pressure, sex, age, total cholesterol (TC), diabetes, and smoking [19].…”

Newly detected atrial fibrillation is associated with cortex-involved ischemic stroke

“…Clinical information such as demographic information, stroke risk factors, detailed medical history, and treatments were assessed as previously described. [4]…”

“…[3] The China Atrial Fibrillation Screening in Acute Ischemic Stroke Patients (CRIST) trial, which recruited consecutive 1556 patients with ischemic and transient ischemic attack (TIA) within 7 days from October 2013 to June 2015, showed that prolonged monitoring evaluation (6 days) could increase AF detection to about 20% in China, of these 4.4% were newly detected AF. [4] However, the available evidence demonstrated no significant benefit of oral anticoagulation for stroke prevention in such patients. [5–7] Although AF is a well-known risk factor for cardioembolic stroke, it is not always directly responsible for the embolism.…”