title: Association of atrial fibrillation with mortality and disability after ischemic stroke.
abstract: OBJECTIVE
  We determined whether patient characteristics (age, sex, comorbidities), stroke severity, and quality of care explained a proportion of the association between atrial fibrillation (AF) and increased disability and mortality in patients with acute ischemic stroke.
  
  
  METHODS
  The study included a prospective cohort of consecutive patients admitted with acute ischemic stroke included in the Registry of the Canadian Stroke Network (July 1, 2003 to March 31, 2008). Multivariable logistic regression analyses were used to determine the magnitude of association between AF and modified Rankin score 4-5 at discharge, 30-day mortality, and 1-year mortality.
  
  
  RESULTS
  There were 10,528 patients admitted with acute ischemic stroke. AF was associated with an increased risk of severe disability and mortality, but the magnitude of association was substantially attenuated in the full multivariable models: modified Rankin score 4-5 at discharge (univariate odds ratio [OR] 1.74, 95% confidence interval [CI] 1.57-1.93; multivariable OR 1.19, 95% CI 1.03-1.36), 30-day mortality (univariate OR 2.52, 95% CI 2.25-2.84; multivariable OR 1.36, 95% CI 1.17-1.58), and 1-year mortality (univariate OR 2.41, 95% CI 2.19-2.66; multivariable OR 1.25, 95% CI 1.10-1.42). Older age and increased stroke severity explained most of the association between AF and poor stroke outcomes. We found no association between AF and poor stroke outcomes in patients receiving therapeutic preadmission oral anticoagulant therapy.
  
  
  CONCLUSIONS
  Older age and increased stroke severity explain most of the association between AF and poorer outcomes after acute ischemic stroke. Nonuse of oral anticoagulant therapy represents the most important modifiable care gap to mitigate the association between AF and poor outcomes after ischemic stroke.
authors.affiliation: HRB Clinical Research Facility Galway, National University of Ireland Galway, Galway, Ireland.
authors.forename: Emer R
authors.initials: ER
authors.lastname: McGrath
authors.forename: Moira K
authors.initials: MK
authors.lastname: Kapral
authors.forename: Jiming
authors.initials: J
authors.lastname: Fang
authors.forename: John W
authors.initials: JW
authors.lastname: Eikelboom
authors.forename: Aengus ó
authors.initials: Aó
authors.lastname: Conghaile
authors.forename: Aengus
authors.initials: A
authors.lastname: O'Conghaile
authors.forename: Michelle
authors.initials: M
authors.lastname: Canavan
authors.forename: Martin J
authors.initials: MJ
authors.lastname: O'Donnell
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants