Ischemic Stroke Severity and Mortality in Patients With and Without Atrial Fibrillation.

Content Provider	Europe PMC
Author	Vinding, Naja E. Kristensen, Søren L. Rørth, Rasmus Butt, Jawad H. Østergaard, Lauge Olesen, Jonas B. Torp‐Pedersen, Christian Gislason, Gunnar H. Køber, Lars Kruuse, Christina Johnsen, Søren P. Fosbøl, Emil L.
Abstract	BackgroundOur objective was to investigate stroke severity and subsequent rate of mortality among patients with and without atrial fibrillation (AF). Contemporary data on stroke severity and prognosis in patients with AF are lacking.Methods and ResultsFirst‐time ischemic stroke patients from the Danish Stroke Registry (January 2005–December 2016) were included in an observational study. Patients with AF were matched 1:1 by sex, age, calendar year, and CHA2DS2‐VASc score with patients without AF. Stroke severity was determined by the Scandinavian Stroke Scale (0–58 points). The rate of death was estimated by Kaplan‐Meier plots and multivariable Cox regression. Among 86 458 identified patients with stroke, 17 205 had AF. After matching, 14 662 patients with AF and 14 662 patients without AF were included (51.8% women; median age, 79.6 years [25th–75th percentile, 71.8–86.0]). More patients with AF had very severe stroke (0–14 points) than patients without AF (13.7% versus 7.9%, P<0.01). The absolute rates of 30‐day and 1‐year mortality were significantly higher for patients with AF (12.1% and 28.4%, respectively) versus patients without AF (8.7% and 21.8%, respectively). This held true in adjusted models for 30‐day mortality (hazard ratio [HR], 1.40 [95% CI, 1.30–1.51]). However, this association became nonsignificant when additionally adjusting for stroke severity (HR, 1.10 [95% CI, 1.00–1.23]). AF was associated with a higher rate of 1‐year mortality (HR, 1.39 [95% CI, 1.32–1.46]), although it was mediated by stroke severity (HR, 1.15 [95% CI, 1.09–1.23], model including stroke severity).ConclusionsIn a contemporary nationwide cohort of patients with ischemic stroke, patients with AF had more severe strokes and higher mortality than patients without AF. The difference in mortality was mainly driven by stroke severity.
Page Count	39
Journal	Journal of the American Heart Association
Volume Number	11
PubMed Central reference number	PMC9245802
Issue Number	4
PubMed reference number	35156393
e-ISSN	20479980
DOI	10.1161/jaha.121.022638
Language	English
Publisher	John Wiley and Sons Inc.
Publisher Date	2022-02-12
Publisher Place	Hoboken
Access Restriction	Open
Rights License	This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
Subject Keyword	atrial fibrillation epidemiology ischemic stroke severity stroke severity Epidemiology Cardiovascular Disease Ischemic Stroke Cerebrovascular Disease/Stroke Atrial Fibrillation
Content Type	Text
Resource Type	Article
Subject	Cardiology and Cardiovascular Medicine