Stroke with atrial fibrillation or atrial flutter: a descriptive population-based study from the Brest stroke registry

Abstract

BackgroundIn the 1990s, epidemiological studies estimated the prevalence of stroke caused by atrial fibrillation (AF) at about 15 %. Given the aging population, there is a rise in the number of AF patients. AF prevention guidelines based on clinical practice and the literature have been published and updated since 2001. Implementation seems to have an impact on the prescription of vitamin K antagonist (VKA). During the last 20 years, few population-based studies have focused on the prevalence of atrial arrhythmia (AA) in patients with stroke. The objective of the present prospective study, using data from 2008, was to evaluate the prevalence of AA (atrial fibrillation/flutter) in patients with stroke and the impact of implementing AF guidelines.MethodsThe prevalence of AA was studied in patients diagnosed with stroke from January 1 to December 31, 2008 in the population-based Stroke Registry of Brest, France (total population, 363,760 according to the 2008 census, with 295,553 aged 15 years or older). Guidelines implementation was assessed in terms of antithrombotic therapy (VKA, antiplatelet agent, none), and the CHADS2 (Congestive heart failure, Hypertension, Age > 75 years, Diabetes mellitus, and prior Stroke or transient ischemic attack).Results851 cases of stroke were identified. The prevalence of AA was 31.7 % (n = 264), and increased with age from < 20 % in patients aged 45 to 54 years to nearly 50 % in patients ≥ 85 years. In patients with AA, 231 strokes were ischemic, 28 hemorrhagic and 5 undetermined. At time of stroke, AA was known in 207 patients (78.4 %). 54 of the 152 patients with CHADS2 score ≥ 2 (35.5 %) were treated with VKA; this proportion decreased with age: 50 % between 50 and 74 years, 43.8 % between 75 and 84 years, and 25 % at 85 years and older.ConclusionThe prevalence of AA in the population-based Brest Stroke Registry in 2008 was higher than that reported by studies conducted 20 years ago. Despite publication of AF prevention guidelines, VKA prescription and use in elderly patients were significantly low.

Atrial Fibrillation as an Ischemic Stroke Clinical and Economic Burden Modifier: A 15-Year Nationwide Study

“…IS hospitalizations increased by 32% from 2000 to 2014, whereas AF-IS episodes more than doubled. Indeed, AF prevalence was 22.6%, which is within the range of 15% to 38% as previously described [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21], and increased along time ($0.9% per year), almost reaching 30% (i.e., 29.3% in 2014). An increasing prevalence of AF in patients with IS had already been described, but not to this extent-the results of both Jespersen et al [7] and Rosengren et al [41] showed an increase of approximately 0.4% per year.…”

“…In fact, studies by Svennberg et al [65] and Lowres et al [67] describe examples from public health policies with good incremental cost-utility ratios between €3142 and €6267. As far as the second problem is concerned, achieving appropriate implementation of stroke prophylaxis guidelines in the real world has proved to be a true challenge, because many factors may play a role, including physicians' previous outcomes and difficulties with international normalized ratio targets, as compiled by Jannou et al [11], although the current availability of the direct oral anticoagulants is overcoming some of these concerns and inducing a higher preventive treatment implementation of AF-related stroke. Thus, the missed opportunities for stroke prevention in AF, highlighted by Gladstone et al [50] long ago, persist in our everyday practice, and our failure to implement quality improvement interventions over this time should persuade us once more to optimize stroke prevention and thus reduce their number and associated costs.…”

“…On top of increasing the risk of death [4], AF is associated with an increased risk of stroke [5], a leading cause of morbidity and mortality worldwide [6]. AF has been documented in a range of 15% to 38% of the patients suffering from an ischemic stroke (IS) [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21].…”

Risk Factor Management in Atrial Fibrillation

“…Findings from recent population-based studies and registries also demonstrated that at least 25-30 % of all patients with an ischaemic stroke and >80 % of those with cardioembolic ischaemic stroke also had AF, suggesting a strong association between these two entities. 3,[33][34][35][36][37][38][39][40] Another important finding in this context was that stroke was the first manifestation of previously unknown AF in >25 % of AF-related strokes. 3,[33][34][35]41 This association was even higher if prolonged noninvasive or invasive monitoring was performed following a stroke.…”

Antithrombotic Therapy Underutilization in Patients With Atrial Flutter

“…Although the risk of stroke associated with AFL is not higher than that associated with AF, studies have shown that high rates of conversion from AFL to AF and the risk of developing stroke itself are not negligible. 9,10,28 According to the logistic regression analysis, risk factors for ACU were being a woman, aspirin utilization, and limited anticoagulant options. Conversely, OAC therapy was better in patients with previous stroke experience, concurrent valvular heart disease, or CHF.…”