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Clinical Summary

Does post-stroke Afib diagnosis reduce the risk for stroke recurrence?

Takeaway

  • No difference was observed in 1-year ischemic stroke recurrence risk between Afib diagnosed after stroke (AFDAS) and sinus rhythm (SR). However, the prevalence of heart disease in AFDAS was lower compared with Afib known before stroke (KAF).
  • The lack of difference is suggestive of a different underlying pathophysiology of AFDAS than that of KAF.

Why this matters

  • KAF is a primarily cardiogenic form of Afib, which includes minimal or no involvement of central neurogenic mechanisms.
  • AFDAS may be an undiagnosed form of KAF possibly resulting from an underlying heart disease.

Study design

  • Retrospective cohort study of 23,376 patients (SR, n=15,885; AFDAS, n=587; KAF, n=6904) with ischaemic stroke.
  • Funding: Ontario Ministry of Health and Long-Term Care.

Key results

  • At 1-year, recurrent stroke was seen in 39 patients with AFDAS, 661 with KAF, and 1,269 with SR (P=.0001).
  • No difference was observed in the risk for recurrent ischemic stroke at 1 year in patients with AFDAS from that of SR (HR, 0.90; P=.57).
  • In patients with AFDAS, prevalence of coronary artery disease (P<.0001), prior myocardial infarction (P<.0001), and congestive heart failure (P<.0001) was significantly lower vs patients with KAF.

Limitations

  • Possible risk for bias.

References


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