Stroke associated with atrial fibrillation - Incidence and early outcomes in the north dublin population stroke study

Niamh Hannon, Orla Sheehan, Lisa Kelly, Michael Marnane, Aine Merwick, Alan Moore, Lorraine Kyne, Joseph Duggan, Joan Moroney, Patricia M.E. McCormack, Leslie Daly, Nicola Fitz-Simon, Dawn Harris, Gillian Horgan, Emma B. Williams, Karen L. Furie, Peter J. Kelly

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)43-49
Number of pages7
JournalCerebrovascular Diseases
Volume29
Issue number1
DOIs
StatePublished - Jan 2009
Externally publishedYes

Keywords

  • Anticoagulation
  • Atrial fibrillation
  • Stroke prevention

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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