Atrial Fibrillation and Stroke Symptoms in the REGARDS Study

Background It is unknown if stroke symptoms in the absence of a stroke diagnosis are a sign of subtle cardioembolic phenomena. The objective of this study was to examine associations between atrial fibrillation (AF) and stroke symptoms among adults with no clinical history of stroke or transient ischemic attack (TIA). Methods and Results We evaluated associations between AF and self‐reported stroke symptoms in the national, prospective REGARDS (Reasons for Geographic and Racial Differences in Stroke) cohort. We conducted cross‐sectional (n=27 135) and longitudinal (n=21 932) analyses over 8 years of follow‐up of REGARDS participants without stroke/transient ischemic attack and stratified by anticoagulant or antiplatelet agent use. The mean age was 64.4 (SD±9.4) years, 55.3% were women, and 40.8% were Black participants; 28.6% of participants with AF reported stroke symptoms. In the cross‐sectional analysis, comparing participants with and without AF, the risk of stroke symptoms was elevated for adults with AF taking neither anticoagulants nor antiplatelet agents (odds ratio [OR], 2.22; 95% CI, 1.89–2.59) or antiplatelet agents only (OR, 1.92; 95% CI, 1.61–2.29) but not for adults with AF taking anticoagulants (OR, 1.08; 95% CI, 0.71–1.65). In the longitudinal analysis, the risk of stroke symptoms was also elevated for adults with AF taking neither anticoagulants nor antiplatelet agents (hazard ratio [HR], 1.41; 95% CI, 1.21–1.66) or antiplatelet agents only (HR, 1.23; 95% CI, 1.04–1.46) but not for adults with AF taking anticoagulants (HR, 0.86; 95% CI, 0.62–1.18). Conclusions Stroke symptoms in the absence of a stroke diagnosis may represent subclinical cardioembolic phenomena or “whispering strokes.” Future studies examining the benefit of stroke symptom screening may be warranted.

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Abstract P406: Atrial Fibrillation (AF) and Stroke Symptoms in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽

10.1161/circ.141.suppl_1.p406 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Meghan Reading Turchioe ◽

Elsayed Z Soliman ◽

Hooman Kamel ◽

Mary Cushman ◽

Orysya Soroka ◽

...

Keyword(s):

Racial Differences ◽

Antiplatelet Agent ◽

Antiplatelet Agents ◽

Embolic Stroke ◽

Cumulative Number ◽

Logistic Regression Models ◽

Stroke Symptom ◽

Stroke Diagnosis ◽

Regards Study ◽

Ischemic Attack

Background: AF-related thromboembolism increases risk of stroke. Stroke symptoms in the absence of a stroke diagnosis may represent “whispering strokes,” but their association with AF has not been well explored. Objective: To examine cross-sectionally the association between AF and self-reported stroke symptoms in the absence of a stroke diagnosis, and whether associations differ by anticoagulant use. Methods: We examined data from 27,072 REGARDS participants without a history of stroke or transient ischemic attack (TIA) at baseline. The presence, type, and cumulative number of self-reported stroke symptoms were compared between participants with and without self-reported history or ECG evidence of AF. Logistic regression models examined associations between AF and stroke symptoms, adjusting for sociodemographic, socioeconomic, stroke risk factors, and geographic characteristics. To investigate the possibility of stroke symptoms representing embolic stroke, results were stratified by anticoagulant or antiplatelet agent use. Results: The mean age of the sample was 64.4(±9.4), 55.3% were women, and 59.2% were black; 2,124 had evidence of AF. Twenty-nine percent of adults with AF and 17% of those without AF reported at least one stroke symptom. Compared to those without AF, the odds ratio (OR) of any stroke symptom was 2.21 (95% CI 1.88-2.58) among adults with AF not using an anticoagulant or antiplatelet agent and 1.93 (95% CI 1.62-2.30) for those on Aspirin or Plavix only ( Table 1 ). Associations were non-significant for those using Warfarin. Similar patterns were observed by each type and cumulative number of stroke symptoms. Conclusion: The association between AF and stroke symptoms suggests that some stroke symptoms in the absence of a stroke diagnosis may represent sub-clinical or “whispering strokes.” The attenuation of this association with Warfarin use but not antiplatelet agents supports the possibility that stroke symptoms in the absence of a stroke diagnosis represent undiagnosed embolic stroke.

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Association of the CHA2D(S2)-VASc Score and Its Components With Overt and Silent Ischemic Brain Lesions in Patients With Atrial Fibrillation

Frontiers in Neurology ◽

10.3389/fneur.2020.609234 ◽

2021 ◽

Vol 11 ◽

Author(s):

Fabienne Steiner ◽

Pascal B. Meyre ◽

Stefanie Aeschbacher ◽

Michael Coslovsky ◽

Tim Sinnecker ◽

...

Keyword(s):

Atrial Fibrillation ◽

Transient Ischemic Attack ◽

Brain Lesion ◽

Brain Lesions ◽

Multicenter Cohort Study ◽

Clinical Trial Registration ◽

Cross Sectional ◽

Ischemic Brain ◽

History Of ◽

Ischemic Attack

Background: Silent and overt ischemic brain lesions are common and associated with adverse outcome. Whether the CHA2DS2-VASc score and its components predict magnetic resonance imaging (MRI)-detected ischemic silent and overt brain lesions in patients with atrial fibrillation (AF) is unclear.Methods: In this cross-sectional analysis, patients with AF were enrolled in a multicenter cohort study in Switzerland. Outcomes were clinically overt, silent [in the absence of a history of stroke/transient ischemic attack (TIA)] and any MRI-detected ischemic brain lesions. Logistic regression analyses were performed to assess the relationship of the CHA2DS2-VASc score and its components with ischemic brain lesions. An adapted CHA2D-VASc score (excluding history of stroke/TIA) for the analyses of clinically overt and silent ischemic brain lesions was used.Results: Overall, 1,741 patients were included in the analysis (age 73 ± 8 years, 27.4% female). At least one ischemic brain lesion was observed in 36.8% (clinically overt: 10.5%; silent: 22.9%; transient ischemic attack: 3.4%). The CHA2D-VASc score was strongly associated with clinically overt and silent ischemic brain lesions {odds ratio (OR) [95% confidence interval (CI)] 1.32 (1.17–1.49), p < 0.001 and 1.20 (1.10–1.30), p < 0.001, respectively}. Age 65–74 years (OR 2.58; 95%CI 1.29–5.90; p = 0.013), age ≥75 years (4.13; 2.07–9.43; p < 0.001), hypertension (1.90; 1.28–2.88; p = 0.002) and diabetes (1.48; 1.00–2.18; p = 0.047) were associated with clinically overt brain lesions, whereas age 65–74 years (1.95; 1.26–3.10; p = 0.004), age ≥75 years (3.06; 1.98–4.89; p < 0.001) and vascular disease (1.39; 1.07–1.79; p = 0.012) were associated with silent ischemic brain lesions.Conclusions: A higher CHA2D-VASc score was associated with a higher risk of both overt and silent ischemic brain lesions.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02105844.

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