New Atrial Fibrillation After Stroke Tied to Preexisting Cardiovascular Comorbidities

Patients who are diagnosed with new atrial fibrillation (AF) after stroke should be carefully surveyed for incident AF to prevent recurrent strokes, according to the results of a longitudinal cohort study published in Stroke.

The study included 336,291 patients; 240,459 did not have AF and 95,832 had previously known AF at baseline. Patients without previous AF had a mean CHA₂DS₂-VASc score of 4.98±1.63. During follow-up (mean, 7.9±11.15 months), approximately 6% of these patients (n=14,095) had incident AF, for an annual incidence of AF after ischemic stroke of 8.9 per 100 person-years (95% CI, 8.8-9.0).

Patients with new AF had higher CHA₂DS₂-VASc scores, were more likely to have comorbidities, and more often had a history of previous transient ischemic attacks than patients who had previously known AF or no AF at all.

Older age, hypertension, heart failure, systemic embolism, coronary artery disease, abnormal renal function, anemia, lung disease, having a pacemaker/implantable cardioverter defibrillator, and valvular disease were among the most powerful predictors of incident AF.

These results imply that preexisting cardiovascular comorbidities play a major role in the likelihood of patients being diagnosed with incident AF after ischemic stroke, particularly because the comorbidities were even more prevalent in these patients than in the patients with previously known AF.

“Risk factors of developing incident AF after [ischemic stroke] are similar to risk factors of thromboembolic events in [patients with] AF,” the researchers concluded. “Such high-risk patients should be closely monitored for incident AF to facilitate an earlier diagnosis of AF.”

Disclosures: Dr Fauchier reports serving as a consultant or speaker for Bayer, Boehringer Ingelheim, BMS/Pfizer, and Medtronic. Dr Angoulvant reports receiving funding from AstraZeneca, Eli Lilly, Novartis, Bayer, Merck Sharp & Dohme, Amgen, and Pfizer. Dr Lip reports serving as a consultant for Bayer/Janssen, BMS/Pfizer, Biotronik, Medtronic, Boehringer Ingelheim, Microlife, Roche, and Daiichi-Sankyo.

Reference

Bisson A, Clementy N, Bodin A, et al. Relationship of preexisting cardiovascular comorbidities to newly diagnosed atrial fibrillation after ischemic stroke [published online September 1, 2017]. Stroke. doi:10.1161/STROKEAHA.117.018251