title: 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%; >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.
authors.affiliation: Neurovascular Clinical Science Unit, Mater University Hospital, Dublin, Ireland.
authors.forename: Niamh
authors.initials: N
authors.lastname: Hannon
authors.forename: Orla
authors.initials: O
authors.lastname: Sheehan
authors.forename: Lisa
authors.initials: L
authors.lastname: Kelly
authors.forename: Michael
authors.initials: M
authors.lastname: Marnane
authors.forename: Aine
authors.initials: A
authors.lastname: Merwick
authors.forename: Alan
authors.initials: A
authors.lastname: Moore
authors.forename: Lorraine
authors.initials: L
authors.lastname: Kyne
authors.forename: Joseph
authors.initials: J
authors.lastname: Duggan
authors.forename: Joan
authors.initials: J
authors.lastname: Moroney
authors.forename: Patricia M E
authors.initials: PM
authors.lastname: McCormack
authors.forename: Leslie
authors.initials: L
authors.lastname: Daly
authors.forename: Nicola
authors.initials: N
authors.lastname: Fitz-Simon
authors.forename: Dawn
authors.initials: D
authors.lastname: Harris
authors.forename: Gillian
authors.initials: G
authors.lastname: Horgan
authors.forename: Emma B
authors.initials: EB
authors.lastname: Williams
authors.forename: Karen L
authors.initials: KL
authors.lastname: Furie
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kelly
mesh_terms: 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
chemical_list: D000925:Anticoagulants