scholarly journals Ischemic Stroke With Atrial Fibrillation

Stroke ◽  
2021 ◽  
Author(s):  
Amélie Gabet ◽  
Charles Guenancia ◽  
Gauthier Duloquin ◽  
Valérie Olié ◽  
Yannick Béjot
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Oral Anticoagulants ◽  
Temporal Trends ◽  
Population Based ◽  
Newly Diagnosed ◽  
Medical File ◽  
Oral Anticoagulant Treatment ◽  
Stroke Registry

Background and Purpose: Because of the aging population, an increase in the prevalence of atrial fibrillation (AF) is currently observed, thus leading to a rise in AF-related ischemic stroke (IS). We analyzed the current prevalence of AF among patients with IS, their characteristics, and temporal trends from 2006 to 2017 in the population-based Dijon Stroke Registry. Methods: We used data from the Dijon Stroke Registry, an ongoing population-based study that records all cases of acute stroke among residents of the city of Dijon. All patients with IS between 2006 and 2017 were included. Previous AF was defined if it was mentioned in the medical file before stroke and newly diagnosed AF if it was diagnosed during the diagnostic workup of patients with acute stroke. Results: During the period 2014 to 2017, among the 796 patients with IS recorded in the Dijon Stroke Registry, 239 (30.0%) had AF, of whom 79 (9.9% of total patients with IS) had newly diagnosed AF, and 98 (12.3%) had previous AF treated with oral anticoagulants. Patients with IS with AF had more disabilities and a higher initial severity according to the National Institutes of Health Stroke Scale compared with those without AF. The age-adjusted prevalence of AF in patients with IS increased between 2006 and 2017 (+9% per time period), with an important increase in men aged 65 to 74 years (+81%) and women aged ≥85 years (+24%), and a significant decrease in women aged 65 to 74 years (−39%). The use of oral anticoagulant treatment in previous AF patients increased between 2006 and 2009 and 2014 and 2017 (29.3% to 61.3%, P <0.0001). However, 37.5% of patients with previous AF and CHADS 2 score ≥2 were not treated with OAC. Conclusions: The increase in AF prevalence in patients with IS could be related to a better diagnosis of this condition. The underuse of oral anticoagulation treatment was still observed.

scholarly journals Atrial Fibrillation in Spontaneous Intracerebral Hemorrhage, Dijon Stroke Registry (2006–2017)

2021 ◽  
Author(s):  
Amélie Gabet ◽  
Valérie Olié ◽  
Yannick Béjot
Keyword(s):  
Atrial Fibrillation ◽  
Intracerebral Hemorrhage ◽  
Scale Score ◽  
Oral Anticoagulants ◽  
Temporal Trends ◽  
Population Based ◽  
Modified Rankin Scale ◽  
Newly Diagnosed ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Stroke Registry

Background Atrial fibrillation (AF) represents a major indication for oral anticoagulants (OAC) that contribute to spontaneous intracerebral hemorrhage (ICH). This study evaluated AF prevalence among patients with ICH, temporal trends, and early functional outcomes and death of patients. Methods and Results Patients with first‐ever ICH were prospectively recorded in the population‐based stroke registry of Dijon, France, (2006–2017). Association between AF and early outcome of patients with ICH (ordinal modified Rankin Scale score and death at discharge) were analyzed using ordinal and logistic regressions. Among 444 patients with ICH, 97 (21.9%) had AF, including 65 (14.6%) with previously known AF treated with OAC, and 13 (2.9%) with newly diagnosed AF. AF prevalence rose from 17.2% (2006–2011) to 25.8% (2012–2017) ( P ‐trend=0.05). An increase in the proportion of AF treated with OAC (11.3% to 17.5%, P ‐trend=0.09) and newly diagnosed AF (1.5% to 4.2%, P ‐trend=0.11) was observed. In multivariable analyses, after adjustment for premorbid OAC, AF was not significantly associated with ordinal modified Rankin Scale score (odds ratio [OR], 1.29; 95% CI, 0.69–2.42) or death (OR, 0.89; 95% CI, 0.40–1.96) in patients with ICH. Nevertheless, adjusted premorbid OAC use remained highly associated with a higher probability of death (OR, 2.53; 95% CI, 1.11–5.78). Conclusions AF prevalence and use of OAC among patients with ICH increased over time. Premorbid use of OAC was associated with poor outcome after ICH, thus suggesting a need to better identify ICH risk before initiating or pursuing OAC therapy in patients with AF, and to develop acute treatment and secondary prevention strategies after ICH in patients with AF.

Abstract WP302: Atrial Fibrillation First Diagnosed at the Time of Ischemic Stroke: A Missed Opportunity

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Daniel E Singer ◽  
Yuchiao Chang ◽  
Leila H Borowsky ◽  
Susan Regan ◽  
Steven M Greenberg
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Stroke Risk ◽  
Massachusetts General Hospital ◽  
Oral Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Newly Diagnosed ◽  
Stroke Event ◽  
Stroke Registry ◽  
Missed Opportunity

Introduction: Atrial fibrillation (AF) is a major cause of ischemic stroke. Individuals with undiagnosed AF lack the stroke risk reduction afforded by oral anticoagulant therapy. In 1983 Wolf documented that 24% (95% CI 14-37) of AF-related strokes had AF first diagnosed at the time of stroke. Given increased medical and lay attention to AF-stroke, we sought to determine whether this percentage had decreased in contemporary care. Hypothesis: Less than 20% of patients with AF-related stroke have their AF first diagnosed at the time of stroke. Methods: We identified patients admitted to Massachusetts General Hospital from 01-01-2010 to 12-31-2013 with a new ischemic stroke and either previously or newly diagnosed AF by searching comprehensive hospital databases for stroke and AF ICD-9 codes in conjunction with a hospital stroke registry. Physician reviewers screened 1037 potentially eligible patients, categorized AF as previously known or newly diagnosed, and performed a structured chart review of the stroke event. To confirm the diagnosis of AF was new, we conducted automated searches for AF terms in the patients’ electronic medical records (EMRs) prior to the stroke admission. Results: We validated 856 cases (83%) as AF and ischemic stroke. AF was considered newly diagnosed in 156/856 (18%; 95%CI: 16-21). In the newly diagnosed group, no patient was on oral anticoagulants and the strokes were consequential (median NIHSS=12; 60% with mRankin of ≥3 at discharge, including 15% deaths). Pre-stroke CHA 2 DS 2 -VASc score was ≥2 in 89%. About half (76/156) had a prior medical encounter in the EMR. Evidence of pre-stroke AF was found in 8/76 records, often peri-procedural, but the AF diagnosis was not carried forward. Conclusions: In this large, contemporary cohort, nearly one in five AF-related strokes occurred in patients who did not carry a pre-stroke AF diagnosis, similar to Wolf’s 1983 finding. The vast majority would have been at high enough pre-stroke risk to merit anticoagulation. Our findings support screening for AF in patients before they have strokes. Further, patients with past transient AF identified via automated EMR searches might merit more intensive screening.

First Diagnosis of Atrial Fibrillation at the Time of Stroke

2017 ◽  
Vol 43 (3-4) ◽  
pp. 192-199 ◽  
Author(s):  
Leila H. Borowsky ◽  
Susan Regan ◽  
Yuchiao Chang ◽  
Alison Ayres ◽  
Steven M. Greenberg ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Medical Records ◽  
Stroke Risk ◽  
Massachusetts General Hospital ◽  
Oral Anticoagulants ◽  
Outcome Data ◽  
Newly Diagnosed ◽  
Stroke Registry ◽  
Code Searches

Background: Atrial fibrillation (AF) is a major cause of ischemic stroke. Individuals with undiagnosed AF lack the stroke protection afforded by oral anticoagulants. We obtained a contemporary estimate of the percentage of AF patients newly diagnosed at the time of stroke. Methods: We identified patients admitted to the Massachusetts General Hospital (MGH) from January 1, 2010 to December 31, 2013 with acute ischemic stroke and either previously or newly diagnosed AF using hospital stroke registry data and stroke and AF ICD-9 code searches of hospital databases. Reviewers categorized AF as previously known or newly diagnosed, and collected comorbidity and outcome data. To confirm AF as newly diagnosed, we searched patients' pre-event electronic medical records (EMRs) for AF terms. Results: AF was considered newly diagnosed in 156/856 patients (18%; 95% CI 16-21). In 136/156 cases, AF was diagnosed using 12-lead EKG, telemetry, or rhythm strips. New AF strokes had a median NIH stroke scale of 12; 60% had mRankin ≥3 at discharge, including 15% deaths. Pre-stroke CHA2DS2-VASc score was ≥2 in 89%. About half (76/156) had prior records in the MGH EMR. Evidence of pre-stroke AF, often peri-procedural, was found in 8/76, but the AF diagnosis was not carried forward. Conclusions: In this contemporary cohort, nearly one in 5 AF-related strokes occurred without a pre-stroke AF diagnosis. AF was readily diagnosed using standard rhythm monitoring. The vast majority of patients with newly diagnosed AF were at high enough pre-stroke risk to merit anticoagulation. In conclusion, our findings support screening for AF before stroke. Patients with past transient AF may merit more intensive screening.

Anticoagulant therapy in practice

2012 ◽  
Vol 153 (19) ◽  
pp. 732-736
Author(s):  
Gergely Hofgárt ◽  
Csilla Vér ◽  
László Csiba
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Health Science ◽  
Science Centre ◽  
Improper Use ◽  
Current Guidelines

Atrial fibrillation is a risk factor for ischemic stroke. To prevent stroke oral anticoagulants can be administered. Old and new types of anticoagulants are available. Nowadays, old type, acenocumarol based anticoagulants are used preferentially in Hungary. Aim: The advantages and the disadvantages of anticoagulants are well known, but anticoagulants are underused in many cases. Method: The authors retrospectively examined how frequent atrial fibrillation was and whether the usage of anticoagulants in practice was in accordance with current guidelines among acute stroke cases admitted to the Department of Neurology, Medical and Health Science Centre of Debrecen University in 2009. Results: Of the 461 acute stroke cases, 96 patients had known and 22 patients had newly discovered atrial fibrillation. Half of the patients did not receive proper anticoagulation. Only 8.4% of them had their INR levels within the therapeutic range. Conclusions: The findings are similar to those reported in other studies. Many factors may contribute to the high proportion of improper use of anticoagulants, and further investigations are needed to determine these factors. In any case, elimination of these factors leading to a failure of anticoagulation may decrease the incidence of stroke. Orv. Hetil., 2012, 153, 732–736.

scholarly journals Risk of Ischemic Stroke in Patients With Non-Valvular Atrial Fibrillation Not Receiving Oral Anticoagulants　― Korean Nationwide Population-Based Study ―

2017 ◽  
Vol 81 (8) ◽  
pp. 1158-1164 ◽  
Author(s):  
Si-Hyuck Kang ◽  
Eue-Keun Choi ◽  
Kyung-Do Han ◽  
So-Ryoung Lee ◽  
Woo-Hyun Lim ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Oral Anticoagulants ◽  
Population Based ◽  
Population Based Study

scholarly journals Temporal trends in antithrombotic treatment of real-world UK patients with newly diagnosed atrial fibrillation: findings from the GARFIELD-AF registry

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e018905 ◽  
Author(s):  
Patricia N Apenteng ◽  
Haiyan Gao ◽  
FD Richard Hobbs ◽  
David A Fitzmaurice
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Temporal Trends ◽  
Bleeding Risk ◽  
P Value ◽  
Newly Diagnosed ◽  
Antithrombotic Treatment ◽  
The Uk

ObjectiveTo investigate evolving patterns in antithrombotic treatment in UK patients with newly diagnosed non-valvular atrial fibrillation (AF).DesignProspective, multicentre, international registry.Setting186 primary care practices in the UK.Participants3482 participants prospectively enrolled in four sequential cohorts (cohort 2 (C2) n=830, diagnosed September 2011 to April 2013; cohort 3 (C3) n=902, diagnosed April 2013 to June 2014; cohort 4 (C4) n=850, diagnosed July 2014 to June 2015; cohort 5 (C5) n=900, diagnosed June 2015 to July 2016). Participants had newly diagnosed non-valvular AF and at least one risk factor for stroke, were aged ≥18, and provided informed consent.Main outcome measuresAntithrombotic treatment initiated at diagnosis, overall and according to stroke and bleeding risks. Stroke risk was retrospectively calculated using CHA2DS2-VASc (cardiac failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled)–vascular disease, age 65–74 and sex category (female)) and bleeding risk using HAS-BLED (hypertension, abnormal renal/liver function (1 point each), stroke, bleeding history or predisposition, elderly (>65), drugs/alcohol concomitantly (1 point each)).Results42.7% were women and the mean age was 74.5 years. The median CHA2DS2-VASc score was 3 in all cohorts and the median HAS-BLED score was 2 in all cohorts. There was a statistically significant increase in the use of anticoagulant therapy from C2 to C5 (C2 54.7%, C3 60.3%, C4 73.1%, C5 73.9%; P value for trend <0.0001). The increase in the use of anticoagulant was mainly in patients with CHA2DS2-VASc ≥2. The use of vitamin K antagonists (VKAs)±antiplatelet (AP) drugs decreased from C2 to C5 (C2 53.3%, C3 52.1%, C4 50.3%, C5 30.6%), while the use of non-vitamin K antagonist oral anticoagulants (NOACs)±AP increased (C2 1.3%, C3 8.0%, C4 22.7%, C5 43.3%). The use of AP only decreased (C2 36.4%, C3 25.5%, C4 11.9%, C5 10.5%), as did the combination therapy of VKA+AP (C2 13.6%, C3 11.0%, C4 9.6%, C5 5.8%).ConclusionThere has been a progressive increase in the proportion of patients newly diagnosed with AF receiving guideline-recommended therapy in the UK, potentially driven by the availability of NOACs.Trial registration numberNCT01090362; Pre-results.

scholarly journals Stroke Patients with Atrial Fibrillation Treated with Oral Anticoagulants: Comparison of the Population-Based Stroke Registry of Dijon and the French National Health Databases

2020 ◽  
Vol 54 (6) ◽  
pp. 506-512
Author(s):  
Amélie Gabet ◽  
Valérie Olié ◽  
Yannick Béjot
Keyword(s):  
Atrial Fibrillation ◽  
National Health ◽  
Oral Anticoagulants ◽  
Population Based ◽  
Stroke Patients ◽  
Stroke Registry ◽  
Health Database ◽  
Administrative Health Databases ◽  
Almost All ◽  
The City

<b><i>Introduction:</i></b> The objective of this study was to evaluate the complementarity of the French national health database (<i>Système national des données de Santé</i>, SNDS) and the Dijon Stroke Registry for the epidemiology of stroke patients with anticoagulated atrial fibrillation (AF). <b><i>Methods:</i></b> The SNDS collects healthcare prescriptions and procedures reimbursed by the French national health insurance for almost all of the 66 million individuals living in France. A previously published algorithm was used to identify AF newly treated with oral anticoagulants. The Dijon Stroke Registry is a population-based study covering the residents of the city of Dijon since 1985 and records all stroke cases of the area. We compared the proportions of stroke patients with anticoagulated AF in the city of Dijon identified in SNDS databases to those registered in the Dijon Stroke Registry. <b><i>Results:</i></b> For the period 2013–2017 in the city of Dijon, 1,146 strokes were identified in the SNDS and 1,188 in the registry. The proportion of strokes with anticoagulated AF was 13.4% in the SNDS and 20.3% in the Dijon Stroke Registry. Very similar characteristics were found between patients identified through the 2 databases. The overall prevalence of AF in stroke patients could be estimated only in the Dijon stroke registry and was 30.4% for the study period. <b><i>Discussion/Conclusion:</i></b> If administrative health databases can be a useful tool to study the epidemiology of anticoagulated AF in stroke patients, population-based stroke registries as the Dijon Stroke Registry remain essential to fully study the epidemiology of strokes with anticoagulated AF.

National trends of use of oral anticoagulants and severities of stroke among patients with atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T.F Chao ◽  
J.N Liao ◽  
G.Y.H Lip ◽  
S.A Chen
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Stroke Prevention ◽  
Oral Anticoagulants ◽  
Temporal Trends ◽  
Daily Practice ◽  
Severity Index ◽  
Stroke Severity ◽  
Research Database ◽  
Prescription Rates

Abstract Background Underuse of oral anticoagulants (OACs) for stroke prevention in patients with atrial fibrillation (AF) is a common issue in the daily practice. The introduction of non-vitamin K antagonist OACs (NOACs) has changed the landscape of stroke prevention in AF. The goal of the present study was to investigate the trends of use of OACs and severities of stroke among AF patients using a nationwide AF database. Methods The present study used the Taiwan Nationwide Health Insurance Research Database (NHIRD). From year 2002 to 2015, a total of 66,331 AF patients aged &gt;20 years who experienced ischemic stroke were identified from 447,259 AF patients. The temporal trends of use of OACs (either warfarin or NOACs) and the severities of stroke were analyzed. The estimated National Institutes of Health Stroke Scale (eNIHSS) calculated by 7-item NHIRD based stroke severity index, which has been validated before, was used to represent the stroke severities. Results The percentages of AF patients who were already anticoagulated when stroke occurred significantly increased from 20.3% in year 2002 to 40.5% in year 2015 (Figure A). The increment was more obvious in the era of NOACs (after year 2012 in Taiwan). In year 2015, NOACs accounts for around 69.6% of prescriptions of OACs. The mean eNIHSS gradually decreased from 17.3 (year 2002) to 14.3 (year 2015) (Figure B). Conclusions In the era of NOACs, the prescription rates of OACs significantly increased among AF patients who experienced ischemic stroke, temporally associated with a decrease in the stroke severity. Funding Acknowledgement Type of funding source: None

Age-dependent anticoagulant therapy for atrial fibrillation patients with intermediate risk of ischemic stroke: A nationwide population-based study

2020 ◽  
Author(s):  
Sun Young Choi ◽  
Moo Hyun Hyun Kim ◽  
Kwang Min Lee ◽  
Young-Rak Cho ◽  
Jong Sung Park ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Lower Risk ◽  
Oral Anticoagulants ◽  
Population Based ◽  
Intermediate Risk ◽  
Composite Outcome ◽  
Population Based Study ◽  
Age Dependent ◽  
Korean National Health Insurance

Background: Although older age is one of the most important risk factors for stroke in atrial fibrillation (AF), it is unclear whether an age threshold exists for which oral anticoagulants (OACs) are beneficial for intermediate-risk AF patients. We sought to investigate the age-dependency of OAC for ischemic stroke in intermediate-risk AF patients. Methods: We enrolled 34,701 AF patients (males with a CHA2DS2-VASc score of 1 and females with a CHA2DS2-VASc score of 2) using the Korean National Health Insurance Service database. The clinical endpoint was the occurrence of ischemic stroke and a composite outcome (ischemic stroke + major bleeding + all-cause death). Results: In AF patients aged ≥ 55 years, OAC therapy was associated with a lower risk of ischemic stroke compared with non-OAC treatment in males (55-59 years: HR 0.79, 95% CI 0.61-0.98, p = 0.038, 60-64 years: HR 0.78, 95% CI 0.61-0.96, p = 0.029, and 65-74 years: HR 0.66, 95% CI 0.49-0.84, p = 0.011) and females (55-59 years: HR 0.76, 95% CI 0.58-0.96, p = 0.027, 60-64 years: HR 0.73, 95% CI 0.55-0.93, p = 0.017, and 65-74 years: HR 0.69, 95% CI 0.51-0.87, p = 0.013). OAC was associated with a lower risk for the composite outcome compared to non-OAC for male and female patients aged ≥ 55 years. Conclusions: Age is an important determinant of ischemic stroke and composite outcome in intermediate-risk AF patients. The benefit of OAC therapy for these AF patients appears to have an age threshold (age ≥ 55 years).

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