Background
Detection of atrial fibrillation (AF) after ischemic stroke is important because anticoagulation
is indicated to reduce the risk of recurrent stroke. However, no consensus exists
about the optimum method for detecting underlying paroxysmal AF not apparent on presentation
with stroke. The aim of this study was to characterize the rate, timing, and predictors
of delayed detection of AF after stroke.
Methods
The Virtual International Stroke Trials Archive provided data from 3464 patients in
the placebo arms of 4 clinical trials of therapies for acute ischemic stroke. Patients
who had AF by history or on the baseline electrocardiogram were excluded. Electrocardiograms
were obtained routinely and as clinically indicated. The time to detection of AF was
evaluated using Kaplan-Meier survival statistics. Cox proportional hazards analysis
was used to evaluate risk factors for AF.
Results
Among 2504 qualifying patients, AF was detected in 174 (6.9%; 95% confidence interval
[CI] 6.0%-8.0%). In 68% of patients, AF was detected more than 48 hours after presentation.
Detection of AF was associated with increasing age (hazard ratio [HR] 1.6/decade;
95% CI 1.4-1.9; P < .005), female sex (HR 1.7; CI 1.2-2.4; P < .005), congestive heart failure (HR 1.9; CI 1.1-3.4; P = .02), and the absence of hypertension (HR 1.6; CI 1.1-2.2; P = .01).
Conclusions
Delayed detection of AF was common in this large cohort of patients carefully monitored
after ischemic stroke. Current methods of screening may fail to detect underlying
paroxysmal AF in a substantial proportion of patients.
Key Words
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Article info
Publication history
Accepted:
January 30,
2009
Received in revised form:
January 26,
2009
Received:
December 13,
2008
Footnotes
Supported by the Larry L. Hillblom Foundation.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2009.01.012
Copyright
© 2009 National Stroke Association. Published by Elsevier Inc. All rights reserved.
