Stroke associated with atrial fibrillation--incidence and early outcomes in the north Dublin population stroke study.
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%; >or=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).


CONCLUSIONS
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.
Hannon
Niamh
N
Neurovascular Clinical Science Unit, Mater University Hospital, Dublin, Ireland.
Sheehan
Orla
O
Kelly
Lisa
L
Marnane
Michael
M
Merwick
Aine
A
Moore
Alan
A
Kyne
Lorraine
L
Duggan
Joseph
J
Moroney
Joan
J
McCormack
Patricia M E
PM
Daly
Leslie
L
Fitz-Simon
Nicola
N
Harris
Dawn
D
Horgan
Gillian
G
Williams
Emma B
EB
Furie
Karen L
KL
Kelly
Peter J
PJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D015994:Incidence; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011159:Population Surveillance; D011446:Prospective Studies; D020127:Recovery of Function; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
D000925:Anticoagulants