scholarly journals A Clinical Score for Predicting Atrial Fibrillation in Patients with Cryptogenic Stroke or Transient Ischemic Attack

Cardiology ◽  
2017 ◽  
Vol 138 (3) ◽  
pp. 133-140 ◽  
Author(s):  
Calvin Kwong ◽  
Albee Y. Ling ◽  
Michael H. Crawford ◽  
Susan X. Zhao ◽  
Nigam H. Shah
Keyword(s):  
Atrial Fibrillation ◽  
Transient Ischemic Attack ◽  
Cryptogenic Stroke ◽  
Significant Risk ◽  
Area Under The Curve ◽  
Clinical Score ◽  
Risk Groups ◽  
Therapeutic Implications ◽  
Using Data ◽  
Ischemic Attack

Objectives: Detection of atrial fibrillation (AF) in post-cryptogenic stroke (CS) or transient ischemic attack (TIA) patients carries important therapeutic implications. Methods: To risk stratify CS/TIA patients for later development of AF, we conducted a retrospective cohort study using data from 1995 to 2015 in the Stanford Translational Research Integrated Database Environment (STRIDE). Results: Of the 9,589 adult patients (age ≥40 years) with CS/TIA included, 482 (5%) patients developed AF post CS/TIA. Of those patients, 28.4, 26.3, and 45.3% were diagnosed with AF 1-12 months, 1-3 years, and >3 years after the index CS/TIA, respectively. Age (≥75 years), obesity, congestive heart failure, hypertension, coronary artery disease, peripheral vascular disease, and valve disease are significant risk factors, with the following respective odds ratios (95% CI): 1.73 (1.39-2.16), 1.53 (1.05-2.18), 3.34 (2.61-4.28), 2.01 (1.53-2.68), 1.72 (1.35-2.19), 1.37 (1.02-1.84), and 2.05 (1.55-2.69). A risk-scoring system, i.e., the HAVOC score, was constructed using these 7 clinical variables that successfully stratify patients into 3 risk groups, with good model discrimination (area under the curve = 0.77). Conclusions: Findings from this study support the strategy of looking longer and harder for AF in post-CS/TIA patients. The HAVOC score identifies different levels of AF risk and may be used to select patients for extended rhythm monitoring.

scholarly journals Clinical Characteristics of Transient Ischemic Attack Patients with Atrial Fibrillation: Analyses of a Multicenter Retrospective Study

2015 ◽  
Vol 5 (2) ◽  
pp. 84-90 ◽  
Author(s):  
Yuka Hama ◽  
Toshiyuki Uehara ◽  
Tomoyuki Ohara ◽  
Kazumi Kimura ◽  
Yasushi Okada ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Transient Ischemic Attack ◽  
Clinical Symptoms ◽  
Multivariate Logistic Regression Analysis ◽  
Ischemic Lesion ◽  
Lesion Pattern ◽  
Disturbance Of Consciousness ◽  
Using Data ◽  
Ischemic Attack ◽  
Single Lesion

Background: Atrial fibrillation (AF) is an important risk factor for transient ischemic attack (TIA). However, little is known about the characteristics of TIA patients with AF. This study investigated the characteristics of such patients, using data from a retrospective, observational, multicenter study. Methods: TIA patients admitted to 13 stroke centers in Japan within 7 days of onset between January 2008 and December 2009 were included. The present analyses compared baseline characteristics, clinical symptoms, findings from diffusion-weighted imaging (DWI), and clinical outcomes between patients with and without AF (AF and non-AF groups). Results: A total of 464 patients (292 men; mean age 68.5 ± 13.2 years) were registered. Of these, 79 patients (17%) had AF. Patients in the AF group were older (73.9 ± 9.1 vs. 67.4 ± 13.6 years, p < 0.001) and more likely to show disturbance of consciousness (13 vs. 6%, p = 0.046) and aphasia (9 vs. 3%, p = 0.007) than patients in the non-AF group. Although no difference in the overall DWI-positive rate was seen between the groups (28 vs. 20%, p = 0.102), a single lesion (23 vs. 10%, p < 0.001), a lesion ≥15 mm (11 vs. 4%, p = 0.006), and a single lesion ≥15 mm (11 vs. 2%, p < 0.001) on DWI were more frequent in the AF group. Multivariate logistic regression analysis identified increased age [odds ratio (OR) 1.04; 95% confidence interval (CI) 1.02-1.07] and DWI single lesion ≥15 mm (OR 5.67; 95% CI 1.92-16.7) as independently associated with the presence of AF. Conclusions: In this study, 17% of our TIA patients had AF. We found an association between the acute ischemic lesion pattern on DWI of a single lesion ≥15 mm and AF in TIA patients. These results might lead to a better diagnosis of TIA patients with AF.

A Retrospective Study of Current Anticoagulant Use in Patients with Atrial Fibrillation: Results from a Managed Care Database.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2246-2246
Author(s):  
Miranda Murray ◽  
Howard Friedman
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Congestive Heart Failure ◽  
Managed Care ◽  
Anticoagulant Therapy ◽  
Transient Ischemic Attack ◽  
Clinical Care ◽  
Significant Risk ◽  
Ischemic Attack

Abstract The vitamin K antagonist warfarin is currently the mainstay of anticoagulant therapy for patients with atrial fibrillation (AF), in whom it has been shown to be effective in preventing stroke. However, it is underused because, despite the quality of clinical care, warfarin can be a difficult drug to manage well. When initiating therapy, patients may require several visits to a coagulation clinic to achieve an international normalized ratio (INR) within the safe and effective range (INR 2–3). Thereafter, frequent monitoring of patients receiving warfarin may still be required due to intrapatient variability. Despite the benefits, studies have shown that approximately 50% of patients who should receive warfarin are not prescribed it or do not receive it. This study was performed to investigate the use of warfarin in eligible patients with AF, for whom it was indicated. Using the US PharMetrics database from 51 managed care organizations, data entered between January 1997 and April 2004, from 5940 patients (>18 years of age with a diagnosis of AF [ICD 9] for whom warfarin was indicated), were analyzed. Patients were excluded if they were not in the database 30 days before and 120 days after their initial diagnosis of AF. Patients were divided into four distinct cohorts, based on treatment patterns: steady users (at least 3 months of warfarin use); discontinued users (used warfarin for only 3 months); non-users (warfarin use for <30 days); and intermittent users (used warfarin prior to first diagnosis of AF, or had less than two prescriptions). Analysis showed that only 31% (1854) of patients were steady users, whereas 59% (3521) of patients were non-users. Also, 4% (246) and 5% (319) of patients were discontinued users and intermittent users, respectively. In addition to a diagnosis of AF, many patients had significant risk factors for stroke: hypertension (48%); diabetes (23%); congestive heart failure (21%); age 75 or older (19%); history of stroke or transient ischemic attack (7%). However, the study showed that patients prescribed warfarin did not have more risk factors compared with long-term steady warfarin users and warfarin non-users (see table). Overall, this study shows that warfarin is underused, even in patients with significant risk factors for stroke, which highlights the need for new, simpler, oral anticoagulant therapy. Risk factors Total population [n (%)] Steady warfarin (%) Discontinued (%) Non-warfarin (%) Intermittent (%) NB Cumulative numbers of risk factors were constructed by assigning one point for each of the following: congestive heart failure; hypertension; age >75; diabetes; with two points added for prior stroke or transient ischemic attack 0 2036 (32) 32 29 36 34 1 1774 (30) 30 27 30 30 2 1197 (20) 22 23 19 23 3 623 (10) 11 13 10 8 4 204 (3) 3 4 4 4 5/6 106 (2) 2 3 1 1

scholarly journals Early and long-term risk of new-onset atrial fibrillation after transient ischemic attack

2021 ◽  
Author(s):  
Francisco Purroy ◽  
Mikel Vicente-Pascual ◽  
Gloria Arque ◽  
Mariona Baraldes-Rovira ◽  
Robert Begue ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Transient Ischemic Attack ◽  
Significant Risk ◽  
Rank Test ◽  
Stroke Recurrence ◽  
Kaplan Meier ◽  
Ischemic Attack ◽  
New Diagnosis ◽  
New Onset

AbstractBackgroundTransient ischemic attack (TIA) provides a unique opportunity to optimize secondary preventive treatments to avoid subsequent ischemic stroke (IS). Although atrial fibrillation (AF) is the leading cause of cardioembolism in IS and anticoagulation prevents stroke recurrence (SR), limited data exists about the risk of new-onset AF after TIA.MethodsWe carried out a prospective cohort study of consecutive patients with TIA from January 2006 to June 2010. The risk of new diagnosis of AF and SR was defined after a median follow-up time of 6.5 (5.0-9.6) years. In a subgroup of consecutive patients, a panel of biomarkers was assessed during the first 24 h of the onset of symptoms.Results723 TIA patients were included. New-onset AF was diagnosed in 116 (16.0%) patients, 42 (36.2%) of them during admission. 204 (28.2%) patients were included in the biomarker substudy. New-onset AF was associated with sex (female) (hazard ratio [HR] 1.61 [95% CI, 1.07-2.41]), age (HR 1.05 [95% CI, 1.03-1.07]), previous ischemic heart disease (HR 1.84 [95% CI 1.15-2.97]) and cortical DWI pattern (HR 2.81 [95% CI 1.87-4.21]). In the Kaplan-Meier analysis, NT-proBNP ≥218.2 pg/ml (log-rank test P<0.001) was associated with significant risk of new-onset AF during the first five years of follow-up. Patients with a new diagnosis of AF after admission and before five years of follow-up had the highest risk of SR (P=0.002).ConclusionThe risk of new diagnosis of AF after TIA is clinically relevant. We identified clinical, neuroimaging and biomarker predictors of new-onset AF.

scholarly journals Evaluation of a clinical score for predicting atrial fibrillation in cryptogenic stroke patients with insertable cardiac monitors: results from the CRYSTAL AF study

2019 ◽  
Vol 12 ◽  
pp. 175628641984269 ◽  
Author(s):  
Susan X. Zhao ◽  
Paul D. Ziegler ◽  
Michael H. Crawford ◽  
Calvin Kwong ◽  
Jodi L. Koehler ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cryptogenic Stroke ◽  
Clinical Score ◽  
Peripheral Vascular ◽  
Stroke Patients ◽  
Group A ◽  
Artery Disease ◽  
Ischemic Attack ◽  
Group B ◽  
Post Hoc

Background: The HAVOC score was previously developed to predict the risk of atrial fibrillation (AF) after cryptogenic stroke (CS) or transient ischemic attack (TIA). The purpose of this study was to apply the HAVOC score to patients who received insertable cardiac monitors (ICMs) in the CRYSTAL AF study. Methods: All patients from the CRYSTAL AF study who received an ICM were included. HAVOC score (one point each for peripheral vascular disease and obesity with body mass index >30, two points each for hypertension, age ⩾ 75, valvular heart disease, and coronary artery disease, 4 points for congestive heart failure) was computed for all patients. The primary endpoint was AF detection by 12 months of ICM monitoring. Results: A total of 214 patients who received ICM were included. AF was detected in 40 patients while the remaining 174 patients were AF negative. The HAVOC score was significantly higher among patients with AF [median 3.0 with interquartile range (IQR) 2–4] than those without AF [median 2.0 (IQR 0–3)], p = 0.01. AF increased significantly across the three HAVOC score groups: 11% in Group A (score 0–1), 18% in Group B (score 2–3), and 32 % in Group C (score ⩾ 4) with p = 0.02. Conclusions: The HAVOC score was shown in this post hoc analysis of CRYSTAL AF to successfully stratify AF risk post CS or TIA. The 11% AF rate in the lowest HAVOC score group highlights the significance of nontraditional contributors to AF and ischemic stroke.

scholarly journals Long-term Arrhythmia Monitoring in Cryptogenic Stroke: Who, How, and for How Long?

2016 ◽  
Vol 10 (1) ◽  
pp. 89-93 ◽  
Author(s):  
Mayra Montalvo ◽  
Rushna Ali ◽  
Brian Silver ◽  
Muhib Khan
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulants ◽  
Cryptogenic Stroke ◽  
Significant Risk ◽  
Hospital Setting ◽  
Persistent Atrial Fibrillation ◽  
Ischemic Attack ◽  
New Generation ◽  
Electrocardiogram Ecg

Cryptogenic stroke and transient ischemic attack (TIA) account for approximately one-third of stroke patients [1]. Paroxys-mal atrial fibrillation (PAF) has been suggested as a major etiology of these cryptogenic strokes [2, 3]. PAF can be difficult to diagnose because it is intermittent, often brief, and asymptomatic. PAF might be more prevalent than persistent atrial fibrillation in stroke and TIA patients, especially in younger populations [4, 5]. In patients with atrial fibrillation, anticoagulation provides significant risk reduction [6]. A new generation of oral anticoagulants has been approved for non-valvular atrial fibrillation, providing a variety of therapeutic options for patients with atrial fibrillation and risk of stroke [7].Prior practice included an admission electrocardiogram (ECG) and continuous telemetry monitoring while in hospital [8]. However, this approach can lead to under-detection of brief asymptomatic events, which can occur at variable intervals, often outside of the hospital setting. Technological advancements have led to devices that can monitor cardiac rhythms outside of the hospital for longer durations resulting in higher yield of detection of atrial fibrillation events.Moreover, recent studies show that the normal monitoring time for arrhythmias may be shorter than ideal in order to detect atrial fibrillation, and increasing this interval could significantly improve detection of atrial fibrillation in these patients [9, 10].The aim of this study is to review the literature in order to define what subgroup of patients, with what methodologies, and for how long monitoring for atrial fibrillation should occur in patients presenting with cryptogenic stroke.

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