1.4 times increase in atrial fibrillation-related ischemic stroke and TIA over 12years in a stroke center


      • Large sample size data from a prospective database
      • 1.4 times increase in AF-related ischemic stroke and TIA over 12 years
      • The increase was not explained by aging or the use of Holter monitoring.


      Background and Purpose

      Prevalence of atrial fibrillation (AF) has quadrupled in the past 50 years in the general population. However, there is uncertainty regarding prevalence of AF over time in ischemic stroke patients given the aging population and enhanced surveillance of AF. We aimed to explore the changing prevalence of AF as well as other risk factors, stroke subtypes, investigations and pre-stroke medications among ischemic stroke and transient ischemic attack (TIA) patients.


      We performed a retrospective analysis of data from a prospective database of consecutive patients with acute ischemic stroke and TIA from 2004 to 2015. Trends in risk factors and other variables year by year were analyzed using logistic regression or median regression.


      Among 6275 patients (median age [interquartile range] 74 [62–82] years, 56% males), the prevalence of AF increased 1.4 times over 12 years (from 23.3% to 32.7%, P < 0.001). The increase in the prevalence of AF remained significant after adjustment for age and the use of Holter monitoring. There was also a significant increase in prevalence of hypertension (67.4% to 77.3%), structural heart disease (9.8% to 10.5%), and previous TIA (10.9% to 13.7%) and a significant decrease in prevalence of dyslipidemia (71.8% to 49.4%).


      There was a 1.4 times increase in the prevalence of AF among consecutive ischemic stroke and TIA patients in the past 12 years in a hospital-based registry. More active screening of the general population for AF may be warranted in order to decrease the overall stroke burden.


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        • Andrade J.
        • Khairy P.
        • Dobrev D.
        • Nattel S.
        The clinical profile and pathophysiology of atrial fibrillation: relationships among clinical features, epidemiology, and mechanisms.
        Circ. Res. 2014; 114: 1453-1468
        • Schnabel R.B.
        • Yin X.
        • Gona P.
        • Larson M.G.
        • Beiser A.S.
        • McManus D.D.
        • et al.
        50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the framingham heart study: a cohort study.
        Lancet. 2015; 386: 154-162
        • Anumonwo J.M.
        • Kalifa J.
        Risk factors and genetics of atrial fibrillation.
        Cardiol. Clin. 2014; 32: 485-494
        • Calenda B.W.
        • Fuster V.
        • Halperin J.L.
        • Granger C.B.
        Stroke risk assessment in atrial fibrillation: Risk factors and markers of atrial myopathy.
        Nat. Rev. Cardiol. 2016; (Published online 07 July 2016)https://doi.org/10.1038/nrcardio.2016.106
        • Sanoski C.A.
        Current approaches to anticoagulation for reducing risk of atrial fibrillation-related stroke.
        J. Pharm. Pract. 2013; 26: 204-213
        • Bjorn-Mortensen K.
        • Lynggaard F.
        • Lynge Pedersen M.
        High prevalence of atrial fibrillation among greenlanders with ischemic stroke - atrial fibrillation found in more than 30% of cases.
        Int. J. Circumpolar Health. 2013; 72: 22628
        • Andrew N.E.
        • Thrift A.G.
        • Cadilhac D.A.
        The prevalence, impact and economic implications of atrial fibrillation in stroke: what progress has been made?.
        Neuroepidemiology. 2013; 40: 227-239
        • Sposato L.A.
        • Cipriano L.E.
        • Saposnik G.
        • Vargas E.R.
        • Riccio P.M.
        • Hachinski V.
        Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: a systematic review and meta-analysis.
        The Lancet Neurology. 2015; 14: 377-387
        • Bembenek J.P.
        • Karlinski M.
        • Mendel T.A.
        • Niewada M.
        • Sarzynska-Dlugosz I.
        • Kobayashi A.
        • et al.
        Temporal trends in vascular risk factors and etiology of urban polish stroke patients from 1995 to 2013.
        J. Neurol. Sci. 2015; 357: 126-130
        • Kotsaftis P.
        • Ntaios G.
        • Savopoulos C.
        • Kiparoglou R.
        • Agapakis D.
        • Baltatzi M.
        • et al.
        Trend in incidence of cardiovascular risk factors in elderly and over-aged stroke patients between 2003 and 2007 in greece.
        Arch. Gerontol. Geriatr. 2010; 50: e31-e35
        • Bogiatzi C.
        • Hackam D.G.
        • McLeod A.I.
        • Spence J.D.
        Secular trends in ischemic stroke subtypes and stroke risk factors.
        Stroke. 2014; 45: 3208-3213
        • Jung K.H.
        • Lee S.H.
        • Kim B.J.
        • Yu K.H.
        • Hong K.S.
        • Lee B.C.
        • et al.
        Secular trends in ischemic stroke characteristics in a rapidly developed country: results from the korean stroke registry study (secular trends in korean stroke).
        Circ. Cardiovasc. Qual. Outcomes. 2012; 5: 327-334
        • Thijs V.
        • Butcher K.
        Challenges and misconceptions in the aetiology and management of atrial fibrillation-related strokes.
        Eur. J. Int. Med. 2015; 26: 461-467
        • Marini C.
        • De Santis F.
        • Sacco S.
        • Russo T.
        • Olivieri L.
        • Totaro R.
        • et al.
        Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a population-based study.
        Stroke. 2005; 36: 1115-1119
        • Paciaroni M.
        • Agnelli G.
        • Corea F.
        • Ageno W.
        • Alberti A.
        • Lanari A.
        • et al.
        Early hemorrhagic transformation of brain infarction: rate, predictive factors, and influence on clinical outcome: results of a prospective multicenter study.
        Stroke. 2008; 39: 2249-2256
        • Bridge F.
        • Thijs V.
        How and when to screen for atrial fibrillation after stroke: insights from insertable cardiac monitoring devices.
        J. Stroke. 2016; 18: 121-128
        • Adams H.P.
        • Bendixen B.H.
        • Kappelle L.J.
        • Biller J.
        • Love B.B.
        • Gordon D.L.
        • et al.
        Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. Toast. Trial of org 10172 in acute stroke treatment.
        Stroke. 1993; 24: 35-41
        • Amarenco P.
        • Lavallee P.C.
        • Labreuche J.
        • Albers G.W.
        • Bornstein N.M.
        • Canhao P.
        • et al.
        One-year risk of stroke after transient ischemic attack or minor stroke.
        N. Engl. J. Med. 2016; 374: 1533-1542
        • Hannon N.
        • Sheehan O.
        • Kelly L.
        • Marnane M.
        • Merwick A.
        • Moore A.
        • et al.
        Stroke associated with atrial fibrillation—incidence and early outcomes in the north dublin population stroke study.
        Cerebrovasc. Dis. 2010; 29: 43-49