Stroke Associated with Atrial Fibrillation – Incidence and Early Outcomes in the North Dublin Population Stroke Study

Abstract

Background: Prospective population-based studies are important to accurately determine the incidence and characteristics of stroke associated with atrial fibrillation (AF), while avoiding selection bias which may complicate hospital-based studies. Methods: We investigated AF-associated stroke within the North Dublin Population Stroke Study, a prospective cohort study of stroke/transient ischaemic attack in 294,592 individuals, according to recommended criteria for rigorous stroke epidemiological studies. Results: Of 568 stroke patients ascertained in the first year, 31.2% (177/568) were associated with AF (90.4%, i.e. 160/177 ischaemic infarcts). The crude incidence rate of all AF-associated stroke was 60/100,000 person-years (95% CI = 52–70). Prior stroke was almost twice as common in AF compared to non-AF groups (21.9 vs. 12.8%, p = 0.01). The frequency of AF progressively increased across ischaemic stroke patients stratified by increasing stroke severity (NIHSS 0–4, 29.7%; 5–9, 38.1%; 10–14, 43.8%; ≥15, 53.3%, p < 0.0001). The 90-day trajectory of recovery of AF-associated stroke was identical to that of non-AF stroke, but Rankin scores in AF stroke remained higher at 7, 28 and 90 days (p < 0.001 for all). Discussion: AF-associated stroke occurred in one third of all patients and was associated with a distinct profile of recurrent, severe and disabling stroke. Targeted strategies to increase anticoagulation rates may provide a substantial benefit to prevent severe disabling stroke at a population level.

Incidence and functional outcome of atrial fibrillation and non-atrial fibrillation- related cardioembolic stroke in Joinville, Brazil: a population-based study

“…These findings are similar to those reported in Adelaide (23%) 3 , Rochester (30.3%) 27 and Iquique (28%) 28 . In contrast, the Dublin study reported 23.1% for AF-related stroke and 12.1% for non-AF-related stroke 23 .…”

Adelaide Stroke Incidence Study

“…The majority of subtyped first-ever strokes were ischemic (84% [95% CI, 78-88]). Intracerebral hemorrhage comprised 11% (8)(9)(10)(11)(12)(13)(14)(15)(16), SAH 3% (1-6), and 3% (1-6) were undetermined.…”

“…15 In the Dublin Stroke study, the presence of AF in association with a stroke, regardless of the cause, was reported in 31% of cases. 16 Applying the TOAST criteria to the Dublin study, 22% of all ischemic strokes were reported as cardioembolic from any cause. 11 In the Perth community stroke study of 1989, 15% of strokes were attributed to embolic infarction after review.…”

Estudo FATA: Prevalência de Fibrilhação Auricular e Terapêutica Antitrombótica nos Cuidados de Saúde Primários de um Concelho do Norte de Portugal

“…2 As embolias relacionadas com a FA são responsáveis por 15% dos acidentes vasculares cerebrais (AVC) 11 , que têm maior gravidade e pior prognóstico. 12 A incidência de AVC na FA não reumática é de cerca de 5% ao ano (quatro a cinco vezes maior que a da população em geral para qualquer grupo etário), 11,13 aumentando para 13 a 14% na FA com valvulopatia concomitante.…”