scholarly journals The comparison of clinical features and clinical outcomes in stroke patients with atrial fibrillation and non-atrial fibrillation: a hospital-based stroke registry in Indonesia

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
N H Karunawan ◽  
R T Pinzon ◽  
B B Siswanto
Keyword(s):  
Atrial Fibrillation ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Clinical Features ◽  
Registry Data ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Stroke Registry ◽  
Statistical Measures ◽  
Prolonged Hospitalization

Abstract Background Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia associated with stroke. Based on the National Health Survey (Riskesdas) the prevalence of stroke in Indonesia increased from 7% in 2013 to 10.9% in 2018. Understanding the clinical features and clinical outcomes differences between AF and non-AF in stroke can help the clinician for further management. Purpose To compare the clinical features and clinical outcomes of stroke patients with AF and non-AF by using the data from the Bethesda Stroke Registry in Indonesia. Methods This cross-sectional study was based on a stroke registry, data were collected using the electronic medical record in our hospital. All patients ≥18 years of age, who developed stroke between January 1, 2011, and December 31, 2018, were included in this study. Data about clinical features and clinical outcomes were collected. The clinical outcomes included mortality, prolonged hospitalization (LOS >6 days), and disability was evaluated using the modified Rankin scale (MRS). The statistical measures calculated were Chi-square-test and Fischer's exact test. Results Data of the total 8447 patients enrolled in the registry, data of 8248 patients who fulfilled inclusion criteria were analyzed, and AF was seen in 226 (2.7%) stroke patents. Comparing with non-AF patients, AF patients were older (47.8% vs 26.0%), higher proportion on of women (48.2% vs39.9%), higher prevalence of ischemic heart disease (16.4% vs 4.7%), loss of consciousness (37.6% vs 23.2%), aphasia (29.6% vs 13.6%) mortality (20.8% vs 10.6%), prolonged hospitalizaton (10.24 [1–80] vs 7.18 [1–73]), worse disability (67.3% vs 43.2%), p<0.05. Comparing with AF patients, non-AF patients had a significantly higher prevalence of hypertension (52.9% vs 40.3%) and diabetes mellitus (33.5% vs 32.7%), p<0.05. Stroke patients with AF was significantly associated with higher in-hospital mortality (RR: 1.19, 95% CI: 1.05–1.35, p<0.001), worse disability (RR: 1.16, 95% CI: 1.11–1.22, p<0.001), and prolonged hospital stay RR: 1.39, 95% CI: 1.22–1.59, p<0.001) than in stroke patents with non-AF. Conclusions AF in stroke affected the poor outcomes by contributing to higher in-hospital mortality, prolonged hospitalization, and worse disability. Older age, Women and IHD were more strongly associated with Stroke n AF than non AF FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Resting Heart Rate and In-Hospital Mortality in Acute Ischemic Stroke Patients With and Without Atrial Fibrillation

2020 ◽  
Vol 84 (4) ◽  
pp. 656-661
Author(s):  
Qiao Han ◽  
Chunyuan Zhang ◽  
Shoujiang You ◽  
Danni Zheng ◽  
Chongke Zhong ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Resting Heart Rate ◽  
Stroke Patients

scholarly journals Stroke patients with atrial fibrillation have a worse prognosis than patients without: data from the Austrian Stroke registry

2004 ◽  
Vol 25 (19) ◽  
pp. 1734-1740 ◽  
Author(s):  
C STEGER ◽  
A PRATTER ◽  
M MARTINEKBREGEL ◽  
M AVANZINI ◽  
A VALENTIN ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Patients ◽  
Stroke Registry ◽  
Worse Prognosis

Abstract WP226: Short Lasting Runs (<30 sec) of Atrial Fibrillation are More Commonly Observed in Ischemic Stroke Patients in Comparison to Controls

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Ethem Murat Arsava ◽  
Ezgi Yetim ◽  
Ugur Canpolat ◽  
Necla Ozer ◽  
Kudret Aytemir ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Multivariate Analyses ◽  
Holter Monitoring ◽  
Female Gender ◽  
Prior History ◽  
Consecutive Series ◽  
Stroke Patients ◽  
Cross Sectional ◽  
History Of

Background: The role of short-lasting (<30 sec) runs of atrial fibrillation (AF) in ischemic stroke pathophysiology is currently unknown. Although these non-sustained attacks are considered as a risk factor for future development of longer lasting, classical AF episodes, prior research has highlighted that associated clinical stroke features are not entirely similar between these two types of arrhythmias. In this study we determined the prevalence of short-lasting AF in stroke-free controls and compared it to a consecutive series of ischemic stroke patients. Methods: A total 235 controls, without any prior history stroke or AF, were evaluated with ECG and 24-hour Holter monitoring for the presence of <30-sec or ≥30-sec lasting AF episodes. The results were compared to a consecutive series of ischemic stroke patients without prior history of AF (n=456). Univariate and multivariate analyses were performed to determine demographic and cardiovascular factors related to <30-sec lasting AF and its association with ischemic stroke. Results: Expectedly, the frequency of newly diagnosed ≥30-sec lasting AF, detected either on ECG or Holter monitoring, was significantly higher in patients with ischemic stroke (18% vs. 2%; p<0.01). Non-sustained AF was positively related to old age (p<0.01), female gender (p=0.01) and hypertension (p<0.01) in univariate analyses. In multivariate analyses, after adjustment for demographic and cardiovascular risk factors, presence of non-sustained AF was significantly higher among both cryptogenic (OR 1.78; 95% CI 1.02-3.10) and non-cryptogenic (OR 1.84; 95% CI 1.15-2.94) stroke patients with respect to controls. Conclusion: Our study shows a higher prevalence of non-sustained AF episodes in ischemic stroke patients in comparison to controls. Whether this cross-sectional association translates into causality in terms of stroke pathophysiology will be the subject of future studies.

Abstract P630: Detection of Atrial Fibrillation by Prolonged Cardiac Monitoring in Cryptogenic and Known Stroke Etiology

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Michal krawczyk ◽  
Sebastián Fridman ◽  
Maria Bres Bullrich ◽  
Palak Shah ◽  
Juan C Vargas-Gonzalez ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Cryptogenic Stroke ◽  
Left Atrial Volume ◽  
Cardiac Monitoring ◽  
Volume Index ◽  
Multivariate Logistic Regression Model ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Therapeutic Decisions

Introduction: Approximately 25% of strokes are classified as cryptogenic (CS), while greater than 50% have an identifiable or ‘known’ etiology (KS). Several studies have demonstrated that prolonged cardiac monitoring (PCM) after cryptogenic stroke substantially increases the detection of atrial fibrillation (AF), but the yield of PCM in KS stroke is unknown. As a result, the majority of guidelines recommend restricting PCM to patients with cryptogenic stroke. If the detection of AF in KS is no different to cryptogenic stroke, it would suggest that this group too would similarly benefit from PCM, with the potential to impact therapeutic decisions (e.g. initiating anticoagulation). Methods: In a cross-sectional study, we compared AF detection by PCM (minimum of 48 hrs) between CS and KS patients without a previous diagnosis of AF. We developed a multivariate logistic regression model by including known and significant clinical, echocardiographic, and radiological factors known to be associated with the detection of AF. We reported results as odds ratios (OR) and 95% confidence intervals (95% CI). Results: We included 561 ischemic stroke patients, 376 with CS and 185 with KS. The median duration of PCM was 167h for CS and 48h for KS. AF was detected in 30 of 376 (8%) CS patients, and 20 of 185 (7.9%) KS patients. Age, history of thyroid disease, clinical presentation of dysarthria, wake-up stroke, and left atrial volume index on echocardiography were significantly associated with a new diagnosis of AF after stroke in the univariable analysis and were thus included in the logistic regression analysis. Additionally, duration of PCM was included in the multivariate model. After adjustment for potential confounders, AF detection by PCM was not significantly higher for CS than KS (OR 0.95, 95% CI 0.25-3.32, P=0.94). Conclusion: To the best of our knowledge this is the first study directly comparing the incidence of AF between CS and KS as the pre-specified primary outcome. Our findings suggest that CS and KS patients have similar rates of AF detection by PCM. Future prospective research is required to confirm these findings and to determine the cost-effectiveness of PCM in non-cryptogenic stroke patients.

scholarly journals The Difference of Barthel Index Score Based on Stroke Severity, Weakness Side, and Onset of Physiotherapy in Ischemic Stroke Patients at Atma Jaya Hospital

2017 ◽  
Vol 6 (02) ◽  
pp. 15
Author(s):  
Agustina Novita Putri Soegiarto ◽  
Linda Suryakusuma ◽  
Jane Pelealu
Keyword(s):  
Ischemic Stroke ◽  
Barthel Index ◽  
Daily Living ◽  
Index Score ◽  
Stroke Severity ◽  
Activity Of Daily Living ◽  
Stroke Patients ◽  
Barthel Index Score ◽  
Cross Sectional ◽  
Stroke Registry

Background: Stroke is the third cause of disability that can affect the Activity of Daily Living (ADL). Ischemicstroke had higher incidence compared to hemorrhagic strokes. Rehabilitation in the form of physiotherapy canreduce the level of ADL dependencies, that is be measured by Barthel Index Score. Stroke severity, weaknessside, and physiotherapy onset can be factors that influence the success of physiotherapy to reducing the levelof ADL dependencies.Methods:A descriptive analytic study with a cross-sectional design in ischemic stroke patients using secondarydata from the Stroke Registry and medical records at Atma Jaya Hospital for the period of January 2016 toDecember 2017. The data were analyzed using Chi-Square.Results: Study on 110 subjects, consisted of 62 men(56.4%), aged divided by under of 58 years, and above of 58years were 52(47.3%) and 58 (52.7%). While subjects divided by stroke severity, i.e. minor, moderate, moderateto severe, and severe; 44 (40%), 58 (52.7%), 5 (4.5%), and 3 (2.7%) respectively. There were 77 participants(70%) had right side weakness and 33 participants (30%) were left side weakness. The changes of Barthel Indexof ADL score, were 73 (66.4%) improvement, 6 (5.5%) deterioration, and 31 (28.2%) remained. The study hasshown relationship between severity of stroke (p=0.008), weakness side (p=0.000), and physiotherapy onset(p=0.039) with the changes of Barthel Indexscore after treatment.Conclusion: There was a relationship between stroke severity, the weakness side of stroke, and physiotherapyonset with the better result of Barthel Index of ADL score after the physiotherapy.Keywords: Activity of Daily Living (ADL), Barthel Index, ischemic stroke, physiotherapy onset, stroke severity,Weakness side

scholarly journals Sex Differences in the Association between Liver Fibrosis and Clinical Outcomes in Acute Cardioembolic Stroke Patients with Nonvalvular Atrial Fibrillation

2021 ◽  
Author(s):  
Lei Yang ◽  
Ke Gao ◽  
Xin-Ye Yao ◽  
Yong-lan Tang ◽  
Wan-Ying Yang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Liver Fibrosis ◽  
Clinical Outcomes ◽  
Normal Liver ◽  
Advanced Fibrosis ◽  
Stroke Patients ◽  
Short Term ◽  
Nonvalvular Atrial Fibrillation ◽  
Severe Stroke ◽  
Advanced Liver Fibrosis

Abstract Background: Liver cirrhosis is a confirmed risk factor for clinical outcomes of stroke patients. However, the contribution of liver fibrosis to cardioembolic stroke (CES) and its short-term outcomes are poorly understood. This study aimed to investigate the association between liver fibrosis and short-term clinical outcomes of acute CES patients, due to nonvalvular atrial fibrillation (NVAF), as well as the impacts of sex on the association. Methods: Using data of 522 patients with NVAF admitted within 48 hours after acute symptom of CES onset. We calculated Fibrosis-4 score (FIB-4) and defined liver fibrosis as: likely advanced fibrosis (FIB-4>3.25), indeterminate (FIB-4, 1.45-3.25), unlikely advanced fibrosis (FIB-4<1.45). We investigated the impact of liver fibrosis degree on stroke severity, major disability at discharge and all cause death at 90 days stratified by sex. Results: Among 522 acute CES patients with NVAF, the mean FIB-4 on admission reflected intermediate fibrosis with largely normal liver enzymes. After adjusting for all confounders, multivariate analyses revealed that likely advanced liver fibrosis was associated with severe stroke (OR=2.21, 95% CI: 1.04-3.54), major disability at discharge (OR=4.59, 95% CI: 1.88-11.18), and 90-days mortality (HR=1.25, 95% CI: 1.10-1.56). Further grouped by sex, these associations were stronger in males but not significant in females.Conclusions: In patients with largely normal liver enzyme, likely advanced liver fibrosis is associated with severe stroke, major disability and all cause death after acute CES due to NVAF, and the association unfolded more obvious in males, but not for females.

Abstract WP379: Sex-specific Effects of Comorbid Diabetes and Depression on Post-stroke Mortality in Individuals With Atrial Fibrillation

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jodi Edwards ◽  
Jessica Colby-Milley ◽  
Jiming Fang ◽  
Limei Zhou ◽  
Baiju R Shah ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hospital Mortality ◽  
Recurrent Stroke ◽  
Stroke Patients ◽  
Comorbid Depression ◽  
Term Care ◽  
Post Stroke ◽  
Specific Effects ◽  
Long Term Mortality

Background: Comorbid diabetes and depression are highly prevalent in atrial fibrillation (AF) and increase the risk of stroke. Women with AF show higher mortality rates and have worse functional outcomes post-stroke. However, the sex-specific effects of comorbid diabetes and depression on mortality and other adverse outcomes in stroke patients with a history of AF is unclear. Methods: Prospectively collected consecutive patients with ischemic stroke and known AF presenting to designated stroke centres in Ontario (2003-2013). Multinomial regression was used to determine sex-specific associations between diabetes and depression and in-hospital mortality post-stroke in individuals with AF. Cox proportional hazards regression was used to estimate the adjusted hazard of long-term mortality post-stroke and competing risks models to estimate hazards of recurrent stroke/TIA, admission to long-term care, and incident dementia post-discharge. Results: Among 5082 stroke patients with known AF (median age=80, IQR:73-85), female patients were more likely to have comorbid depression than males (63.5% vs. 36.5%) and those with comorbid diabetes and depression were younger (77 yrs) and had more vascular history (HTN, CAD, hyperlipidemia) than those with AF only. For males, comorbid diabetes increased the likelihood of in-hospital mortality post-stroke by 53% (OR=1.53, 95% CI=1.16-2.02), after adjustment for stroke severity, demographic and clinical factors, while comorbid depression did not significantly impact in-hospital mortality and neither diabetes or depression affected in-hospital mortality post-stroke for females. However, diabetes was independently associated with increased hazard of long-term mortality for both female (HR=1.15, 95%CI=1.02-1.29) and male AF stroke patients (HR=1.35, 95%CI=1.19-1.53). No associations with recurrent stroke/TIA, institutionalization or dementia post-stroke were observed for either females or males. Conclusion: In stroke patients with known AF, comorbid diabetes but not depression was independently associated with increased in-hospital mortality for males and increased long-term mortality post-stroke for both females and males.

Abstract T P158: Albuminuria Is Associated With Neurological Deterioration and Poor Outcome in Acute Stroke Patients With Non-valvular Atrial Fibrillation: The SAMURAI-NVAF Study

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Takayuki Matsuki ◽  
Masatoshi Koga ◽  
Shoji Arihiro ◽  
Kenichi Todo ◽  
Hiroshi Yamagami ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Acute Stroke ◽  
Clinical Outcomes ◽  
Reperfusion Therapy ◽  
Neurological Deterioration ◽  
Stroke Patients ◽  
Multicenter Observational Study ◽  
Spot Urine ◽  
Poor Outcome ◽  
The Impact

Background and purpose: The impact of albuminuria on clinical outcomes in acute cardioembolic stroke is not fully investigated. We assessed whether high spot urine albumin/creatinine ratio (ACR) was associated with clinical outcomes in acute stroke with non-valvular atrial fibrillation (NVAF). Methods: From 2011 to 2014, we enrolled acute ischemic stroke/TIA patients with NVAF in the SAMURAI-NVAF study, which is a multicenter, observational study. Patients with complete ACR values were included in the analysis. They were divided into the N (normal, ACR < 30mg/g) and the H (high, ACR ≥ 30mg/g) groups. Clinical outcomes were neurological deterioration (an increase of NIHSS ≥1 point during the initial 7 days) and poor outcome (mRS of 4-6 at 3 months). Results: Of 558 patients (328 men, 77±10 y) who were included, 271 and 287 were assigned to the H group and the N group, respectively. As compared with patients in the N group, those in the H group were more frequently female (52 vs 31%, p < 0.001) and older (80±10 vs 75±10 y, p < 0.001). On admission, patients in the H group more frequently had diabetes (28 vs 17%, p = 0.003), less frequently had paroxysmal AF (68 vs 57%, p = 0.009), had higher levels of SBP (157±28 vs 151±24 mmHg, p = 0.003), NIHSS score (11 vs 5, p < 0.001), CHA2DS2-VASc score (6 vs 5, p < 0.001), plasma glucose (141±62 vs 132±41 mg/dL, p = 0.04), and brain natriuretic peptide (348±331 vs 259±309 pg/mL, p = 0.002), and had lower levels of hemoglobin (13±2 vs 14±2 g/dL, p = 0.02), and estimated glomerular filtration ratio (eGFR) (60±24 vs 66±20 mL/min/1.73m2 p = 0.002). On imaging studies, patients in the H group more frequently had large infarct (29 vs 20 %, p = 0.02) and culprit artery occlusion (64 vs 48%, p < 0.001). Neurological deterioration (14 vs 4%, p < 0.001) and poor outcome (49 vs 24%, p < 0.001) were more frequently observed in the H group. On multivariate regression analysis adjusted for significant confounders and reperfusion therapy, the H group was associated with neurological deterioration (OR 2.43; 95% CI 1.14-5.5; p = 0.02) and poor outcome (OR 2.75; 95% CI 1.45-5.2; p = 0.002), although eGFR was not significantly related to either. Conclusion: High ACR, a marker of albuminuria, was independently associated with unfavorable outcomes in acute stroke patients with NVAF.

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