The clinical outcome comparison of ischemic stroke with and without atrial fibrillation

Сравнение клинического исхода ишемического инсульта с фибрилляцией предсердий и без нее
Rizaldy Taslim Pinzon 1 * , Fransiscus Buwana 1
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1 Neurology Department, Faculty of Medicine, Duta Wacana Christian University, Yogyakarta, Indonesia
* Corresponding Author
J CLIN MED KAZ, Volume 2, Issue 52, pp. 37-41. https://doi.org/10.23950/1812-2892-JCMK-00676
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ABSTRACT

Background: Atrial fibrillation increases the risk of stroke and is associated with poor stroke outcomes. The primary concern of this study was to compare the clinical outcome of ischemic stroke patients with atrial fibrillation and without atrial fibrillation.
Methods: This was a retrospective cohort study using secondary data from electronic medical record and electronic stroke registry of Bethesda Hospital Yogyakarta, Indonesia. The data was collected from 2017-2018. The presence of atrial fibrillation at stroke onset and during the acute phase was confirmed by a standard electrocardiogram. The primary outcomes of the study was in-hospital mortality, disability measured by modified Rankin Scale (mRS), and length of stay. We used SPSS 20 with significance level 0,05.
Results: Among 1688 patients with ischemic stroke, 45(2,67%) had atrial fibrillation. 51,11% of patients with AF were males and 82,22% aged above 60 years. The mortality of stroke patients with atrial fibrillation group is eighteen patients (40.0%), thirty seven patients (84.4%) have poor functional outcome (mRS≥2) and have length of stay 6 (0-41) days. Bivariate analysis showed stroke patients with atrial fibrillation group is significantly associated with higher in-hospital mortality (RR: 2.11; 95% CI: 1.09-2.22; p: 0.001), worse disability (RR: 2.09; 95% CI: 1.92-2.32; p: 0.001) and prolonged hospital stay (6 (0-41) vs 4 (0-14), p:0.001) than in stroke patients without atrial fibrillation group.
Conclusion: Atrial fibrillation is associated with stroke outcomes. Careful cardiac evaluation and appropriate treatment are needed to improve the poor outcomes in patients with ischemic stroke and atrial fibrillation.
Keywords: atrial fibrillation, ischemic stroke, comparison, clinical outcome

CITATION

Pinzon RT, Buwana F. The clinical outcome comparison of ischemic stroke with and without atrial fibrillation. Journal of Clinical Medicine of Kazakhstan. 2019;2(52):37-41. https://doi.org/10.23950/1812-2892-JCMK-00676

REFERENCES

  • Chin JH and Vora N. The global burden of neurologic diseases. Neurology. 2014; 83(4): 349-351. https://doi.org/10.1212/WNL.0000000000000610
  • Benjamin EJ, Blaha MJ, Chiuve SE. American Heart Association Statistics Committee and Stroke Statistics Subcommittee: a report from the American Heart Association. Circulation. 2018; 135:e229-e445. https://doi.org/10.1161/CIR.0000000000000558 
  • P2PTM Kemenkes RI. Germas Cegah Stroke [In Indonesia]. 2018; Available from www.p2ptm.kemenkes.go.id.
  • Go AS, Hylek EM, Phillips KA, Chang Y,Henault LE, Selby JV, Singer DE: Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001; 285: 2370-2375 https://doi.org/10.1001/jama.285.18.2370
  • XDeng YX, Wang YL, Gao BQ, Wang CX, Zhao XQ, Liu LP, Wang AX, Zhou Y, Liu GF, Du WL, Zhang N, Jing J, Meng X, et al. Age Differences in Clinical Characteristics, Health care, and Outcomes after Ischemic Stroke in China. CNS Neuroscience & Therapeutics. 2012; 18:819-26. https://doi.org/10.1111/j.1755-5949.2012.00378.x
  • Indonesian Heart Association. Guidelines for Management of Atrial Fibrillation. Edition 1; 2014.
  • Romero JR, Wolf PA. Epidemiology of stroke: legacy of the Framingham Heart Study. Glob Heart. 2013; 8:67-75. https://doi.org/10.1016/j.gheart.2012.12.007
  • Wibisono A. Associations between Atrial Fibrillation and Ischemic Stroke in Moewardi General Hospital [Thesis] Surakarta: Faculty of Medicine Muhammadiyah Surakarta; 2012.
  • XKishore A, Vail A, Majid A, Dawson J, Lees KR, Tyrrell PJ, et al. Detection of atrial fibrillation after ischemic stroke or transient ischemic attack: a systematic review and meta-analysis. Stroke. 2014; 45:520-526. https://doi.org/10.1161/STROKEAHA.113.003433
  • Friberg L, Rosenqvist M, Lindgren A, Terent A, Norrving B, Asplund K. High Prevalence of Atrial Fibrillation Among Patients With Ischemic Stroke. Stroke AHA Journal. 2014; 45:2599-2605 https://doi.org/10.1161/STROKEAHA.114.006070
  • Hannon N, Sheehan O, Kelly L, Marnane M, Merwick A, Moore A, Kyne L, Duggan J, Moroney J, Daly L, Harris D, Horgan G, Furie K. Stroke Associated with Atrial Fibrillation-Incidence and Early Outcomes in the North Dublin Population Stroke Study. Journal of Cerebrovascular Disease. 2010; 29:43-49. https://doi.org/10.1159/000255973
  • Banks J.L., Marotta C.A. Outcomes Validity and Reliability of the Modified Rankin Scale: Implications for Stroke Clinical Trials. Stroke. 2007; 38:1091-1096. https://doi.org/10.1161/01.STR.0000258355.23810.c6
  • Guo Y, Wang H, Tian Y, Wang Y, Lip GY. Multiple Risk Factors and Ischaemic Stroke in the Elderly Asian Population With and Without Atrial Fibrillation. An analysis of 425,600 Chinese Individuals Without Prior Stroke. Thromb Haemost. 2016; 115:184-192 https://doi.org/10.1160/TH15-07-0577
  • Akanksha W, Paramdeep K, Gagandeep S, Rajinder B, Birinder P, Monika S. Clinical features, Risk factors, and Short-term Outcome of Ischemic Stroke, in Patients with Atrial Fibrillation: Data from a population-based study. Ann Indian Acad Neurol. 2017; 20:289-93. https://doi.org/10.4103/aian.AIAN_16_17
  • Lip GY. Atrial Fibrillation in Patients with Hypertension: Trajectories of Risk Factors in Yet Another Manifestation of Hypertensive Target Organ Damage. Hypertension 2016; 68:544-545. https://doi.org/10.1161/HYPERTENSIONAHA.1
  • Yaghi S, Pilot M, Song C. Ischemic Stroke Risk After Acute Coronary Syndrome. J Am Heart Assoc. 2016; 5(7):e002590. https://doi.org/10.1161/JAHA.115.002590
  • Mallick AK, Ali MA, Kafiluddin M, Amin MP, Kundu PK, Alahi M, Yusuf N. Study on outcome of ischemic stroke patient with atrial fibrillation. KYAMC Journal. 2018; 8(2). https://doi.org/10.3329/kyamcj.v8i2.35696
  • Cerebral Embolism Task Force. Cardiogenic brain embolism. Arch Neurol.1986; 43:71-84. https://doi.org/10.1001/archneur.1986.00520010065026
  • Hahne K, Mönnig G, Samol A. Atrial fibrillation and silent stroke: links, risks, and challenges. Vascular Health and Risk Management. 2016; 12:65-74. https://doi.org/10.2147/VHRM.S81807
  • Lavy S, Stern S, Melamed E. Effect of chronic atrial fibrillation on regional cerebral blood flow. Stroke. 1980; 11:35-8. https://doi.org/10.1161/01.STR.11.1.35
  • Saposnik G, Gladstone D, Raptis R, Zhou L, Hart R. Atrial Fibrillation in Ischemic Stroke Predicting Response to Trombolysis and Clinical Outcomes. Stroke AHA Journal. 2013; 44:99-104. https://doi.org/10.1161/STROKEAHA.112.676551
  • McGrath, Kapral M, Fang J, Eikelboom J, O’Conghaile A, Canavan M, O’Donnell M. Association of Atrial Fibrillation with Mortality and Disability after Ischemic Stroke. Neurology. 2013; 81:825-832 https://doi.org/10.1212/WNL.0b013e3182a2cc15
  • Lie, Zhao X, Wang C, Liu L, Liu G, Wang Y, Wang C, Jing J, Wang YJ.Risk factors for poor outcome and mortality at 3 months after the ischemic stroke in patients with atrial fibrillation. J Stroke Cerebrovasc Dis. 2013; 22(8):e419-25. https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.04.025
  • Bhalla A, Grieve R, Tilling K, Rudd AG, Wolfe CD. Older stroke patients in Europe: stroke care and determinants of outcome. Age Ageing. 2004; 33(6):618-624. https://doi.org/10.1093/ageing/afh219
  • Tomita F, Kohya T, Sakurai M, et al; Hokkaido Atrial Fibrillation Study Group. Prevalence and clinical characteristics of patients with atrial fibrillation: analysis of 20,000 cases in Japan. Jpn Circ J. 2000; 64:653-8. https://doi.org/10.1253/jcj.64.653
  • Gustafsson C, Britton M. Pathogenetic mechanism of stroke in non-valvular atrial fibrillation: follow-up of stroke patients with and without atrial fibrillation. J Intern Med. 1991; 230:11-16. https://doi.org/10.1111/j.1365-2796.1991.tb00400.x
  • Kaarisalo MM, Immonen-Raiha P, Marttila RJ. Atrial fibrillation and stroke. Mortality and causes of death after the first acute ischemic stroke. Stroke. 1997; 28:311-15. https://doi.org/10.1161/01.STR.28.2.311
  • Fauchier L, Villejoubert O, Clementy N, Bernard A, Pierre B, Angoulvant D, Ivanes F, Babuty D. Causes of Death and Influencing Factors in Patients with Atrial Fibrillation. The American Journal of Medicine. 2016; 129:-128. https://doi.org/10.1016/j.amjmed.2016.06.045
  • Kruchov S, Frost L, Eagle K, Paaske S. Atrial Fibrillation in Patients with Ischemic Stroke: A Population-based Study. Clinical Epidemiology. 2009; 55-65. https://doi.org/10.2147/CLEP.S4794
  • Kimura K, Minematsu K, Yamaguchi T. Atrial fibrillation as a predictive factor for severe stroke and early death in 15 831 patients with acute ischaemic stroke. J Neurol Neurosurg Psychiatry. 2005; 76:679-683. https://doi.org/10.1136/jnnp.2004.048827
  • Steger C, Pratter A, Martinek-Bregel M, et al. Stroke patients with atrial fibrillation have a worse prognosis than patients without: data from the Austrian Stroke registry. Eur Heart J. 2004; 25(19):1734-1740. https://doi.org/10.1016/j.ehj.2004.06.030