Patients who had an ischemic stroke with atrial fibrillation (AF) had an increased risk for in-hospital fatality and adverse events (AEs), according to study results published in the journal Heart Rhythm Case Reports.
The aim of this study was to assess the effect AF has on the outcomes and AEs of patients who have been hospitalized for ischemic strokes. This study incorporated data from the German Diagnosis Related Groups system to identify patients who had an ischemic stroke between 2005 and 2015. Researchers used diagnostic, surgical, and interventional procedure codes to identify, classify, and assess patients. Outcomes of interest included in-hospital death and AEs, such as mechanical ventilation, cardiopulmonary resuscitation (CPR), pneumonia, pulmonary embolism, and more.
Of the 2,958,697 hospitalized patients with ischemic strokes, 50.5% were women, 65.4% were >70 years old, 28.7% had AF, and 9% died in the hospital. Patients with AF were more often older (median age, 80 vs 73 years old; P <.001), were more likely women (58.3% vs 47.3%; P <.001), had a longer hospital stay (12 vs 9 days; P <.001), and had a higher prevalence of cardiovascular disease than patients without AF.
In-hospital fatality rates for patients with AF was 13% whereas fatality rates for patients without AF was 7.3% (P <.001). The risk ratio indicated that AF had a greater effect on younger patients.
Likewise, patients with AF had an increased prevalence of shock (1.2% vs 0.7%; P <.001), myocardial infarction (3.3% vs 2.1%; P <.001), CPR (1.3% vs 0.8%; P <.001), and pneumonia (9.8% vs 5.3%; P <.001) when compared with patients without AF.
Multivariate regression analysis indicated AF was an independent predictor for patients hospitalized for ischemic stroke (odds ratio [OR] 1.3; 95% CI, 1.28-1.31; P <.001). Atrial fibrillation was also an independent risk factor for the development of pneumonia (OR 1.52; 95% CI, 1.5-1.53; P <.001), venous thromboembolism (OR 1.08; 95% CI, 1.05-1.1; P <.001), myocardial infarction (OR 1.06; 95% CI, 1.05-1.08; P <.001), shock (OR 1.45; 95% CI, 1.41-1.49; P <.001), adverse in-hospital events (OR 1.43; 95% CI, 1.42-1.44; P <.001), CPR (OR 1.39; 95% CI, 1.35-1.43; P <.001) and bleeding events (OR 1.82; 95% CI, 1.79-1.85; P <.001).
Limitations of this study include the use of a database for data extraction, which could include incomplete or inaccurate coding, and the inability to assess the use of oral anticoagulant treatments.
The researchers concluded that patients hospitalized for ischemic stroke who had AF experienced a “significant higher case fatality rate and rate of [AEs] during hospitalization irrespectively of patients’ age, sex and important comorbidities.”
Keller K, Hobohm L, Wenzel P, Münzel T, Espinola-Klein C, Ostad MA. Impact of atrial fibrillation/flutter on the in-hospital mortality of ischemic stroke patients [published online October 4, 2019]. Heart Rhythm. doi: 10.1016/j.hrthm.2019.10.001