Atrial fibrillation in patients with ischaemic stroke in the Swedish national patient registers: how much do we miss?

Abstract

Despite the high specificity, AF diagnosis in the Swedish Patient Register assessed in the population of ischaemic stroke patients and age- and gender-matched control subjects has modest sensitivity, which may result in underestimating prevalent and incident AF cases if only register data are used for identification of subjects with AF in epidemiology studies.

Atrial time and voltage dispersion are both needed to predict new-onset atrial fibrillation in ischemic stroke patients

“…In total, 2588 ECG’s were reviewed with a median number of ECG recordings per person of four (IQR 1–9) [8]. New onset atrial fibrillation was found in 39 (17%) of the stroke patients (Hazard ratio 1.49, 95% confidence interval 0.09–2.35, p  = 0.121) as previously reported [2, 8]. The median time to AF onset was 3.2 (IQR 1.3 to 5.9) years.…”

“…The Cause of Death Register is also provided by the Swedish National Board of Health and Welfare and contains information (since 1961) from death records, including underlying causes of death and up to 20 contributory causes of death coded to the current edition (ICD-10). The presence of the ICD-10 code I48 in the Swedish national registers identified AF diagnosis with high specificity and modest sensitivity as we showed recently in a validation study on patients with ischemic stroke enrolled in the LSR [2]. …”

“…A high prevalence of AF is noted in ischemic stroke patients [1]. The impact of ischemic stroke on the risk of subsequent development of AF is only beginning to become clear [2, 3]. Information on development of new AF in ischemic stroke patients using ECG monitoring has been seldom reported until recently [4–6].…”

Predictors of new onset atrial fibrillation during 10-year follow-up after first-ever ischemic stroke

“…The presence of ICD-10 I48 code in the Swedish national registers identified AF diagnosis with high specificity and modest sensitivity as we showed recently in a validation study on patients with ischemic stroke enrolled in the LSR [19].…”

Body size and risk of atrial fibrillation: a cohort study of 1.1 million young men

“…It is a further strength that the validity of the Patient register has been shown to be good with increasing positive predictive values through the last decades [30]. For atrial fibrillation, the positive predictive value is estimated at 93-97% [30,31].…”