scholarly journals Relationship of Preexisting Cardiovascular Comorbidities to Newly Diagnosed Atrial Fibrillation After Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (10) ◽  
pp. 2878-2880 ◽  
Author(s):  
Arnaud Bisson ◽  
Nicolas Clementy ◽  
Alexandre Bodin ◽  
Denis Angoulvant ◽  
Dominique Babuty ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Newly Diagnosed ◽  
Cardiovascular Comorbidities ◽  
Relationship Of

Abstract MP75: Geographic Variation in Stroke Rates and Oral Anticoagulation Use among Medicare Beneficiaries with Atrial Fibrillation

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Inmaculada Hernandez ◽  
Samir Saba ◽  
Yuting Zhang
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Geographic Variation ◽  
Newly Diagnosed ◽  
Medicare Beneficiaries ◽  
The West ◽  
North Central ◽  
Census Division ◽  
Adjusted Rate ◽  
West North Central

Background: Recent studies have shown strong geographic variation in oral anticoagulation (OAC) use in atrial fibrillation (AF); however, it remains unknown how this contributes to the geographic variation in ischemic stroke observed across the US. The objective of the present study was to evaluate the relationship between the geographic variation in the initiation of OAC and the incidence of ischemic stroke in a cohort of Medicare beneficiaries newly diagnosed with AF. Methods: Using 2013-2014 claims data from a 5% random sample of Medicare beneficiaries, we identified patients newly diagnosed with AF in 2013-2014 and categorized them according to their initiation of OAC. Our sample included 21,226 OAC initiators and 20,068 patients who did not initiate OAC therapy. We assigned each patient to one of the 9 US Census Divisions using the zip code, and collected their medical claims with a diagnosis of ischemic stroke. We constructed logistic regression models to estimate the average adjusted probability of OAC initiation and Poisson models to estimate the average adjusted rate of ischemic stroke, in each Census Division. Both estimates were adjusted for demographics, eligibility for Medicaid coverage and for low-income subsidy, enrollment in a Medicare Advantage Part D plan, and a comprehensive list of clinical characteristics. We computed the correlation between the average adjusted probability of OAC initiation and the average adjusted rate of ischemic stroke at the Census Division level. Results: The probability of OAC initiation was lowest in the West South Central (0.47) and highest in the West North Central (0.54) and New England (0.54). The average adjusted rate of ischemic stroke was lowest in the West North Central (0.09) and highest in the South Atlantic (0.14) and South West Central (0.14). The average adjusted probability of OAC initiation at the Census Division level and the average adjusted rate of ischemic stroke were inversely correlated, with R=-0.576, p-value=0.10. This suggests that variation in OAC initiation likely explains at least a third of geographic variation in ischemic stroke [R 2 =(-0.576) 2 =0.332]. Conclusions: Our results suggest that geographic variations in OAC initiation within the U.S. explain, in part, variations in the incidence of ischemic stroke among AF patients. Further mechanistic research using advanced causal mediation models is warranted.

scholarly journals Clustering of healthy lifestyle behaviors is associated with a lower incidence of adverse events in patients with newly diagnosed atrial fibrillation: a nationwide cohort study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S R Lee ◽  
E K Choi ◽  
K D Han ◽  
S Oh ◽  
G Y H Lip
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Adverse Events ◽  
Healthy Lifestyle ◽  
Health Screening ◽  
Major Adverse Cardiovascular Events ◽  
Lifestyle Behaviors ◽  
Newly Diagnosed ◽  
Healthy Lifestyle Behaviors

Abstract Background Although unhealthy or healthy lifestyle behaviors tend to be clustered, studies on the risk of clinical outcomes depending on how the lifestyle behaviors are managed after atrial fibrillation (AF) diagnosis remain limited. Purpose We aimed to evaluate the association between a cluster of healthy lifestyle behaviors and the risk of adverse outcomes in patients with AF. Methods Using the Korean National Insurance Service database, patients who were newly diagnosed as nonvalvular AF between 2009 and 2016 and received national health screening examination within 2-year after AF diagnosis were included. A healthy lifestyle behavior score (HLS) was calculated by assigning 1 point each for “non-current” smoking, for non-drinking, and for performing regular exercise from the self-reported questionnaire in health screening examinations. The primary outcome was defined as major adverse cardiovascular events (MACE), including ischemic stroke, myocardial infarction, and hospitalization for heart failure. The secondary outcomes included individual components of the primary composite outcome and all-cause death. Results A total of 208,662 patients were included and 7.1%, 22.7%, 58.6%, and 11.6% were HLS 0, 1, 2, and 3 group, respectively. After multivariable adjustment, patients with HLS 1, 2, and 3 were associated with lower risks of MACE compared to those with HLS 0 (adjusted hazard ratio [95% confidence interval]: 0.788 [0.762–0.855], 0.654 [0.604–0.708], and 0.579 [0.527–0.636], respectively) (Figure). Increased number of healthy lifestyle behaviors were associated with lower risks of ischemic stroke, hospitalization for heart failure, and all-cause death. The risk reduction of healthy lifestyle combinations was consistently observed in various subgroups, regardless of CHA2DS2-VASc score and oral anticoagulant use. Conclusion Increased number of healthy lifestyle behaviors were significantly associated with lower MACE and all-cause death risks in patients with new-onset AF. These findings support the promotion of a healthy lifestyle to reduce the risk of adverse events in AF patients. FUNDunding Acknowledgement Type of funding sources: None.

Burden, timing, and relationship of cardiovascular hospitalization to mortality among Medicare beneficiaries with newly diagnosed atrial fibrillation

2013 ◽  
Vol 166 (3) ◽  
pp. 573-580 ◽  
Author(s):  
Mintu P. Turakhia ◽  
Matthew D. Solomon ◽  
Mehul Jhaveri ◽  
Pamela Davis ◽  
Michael R. Eber ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Newly Diagnosed ◽  
Medicare Beneficiaries ◽  
Relationship Of

scholarly journals Voxelwise distribution of acute ischemic stroke lesions in patients with newly diagnosed atrial fibrillation: Trigger of arrhythmia or only target of embolism?

PLoS ONE ◽  
2017 ◽  
Vol 12 (5) ◽  
pp. e0177474 ◽  
Author(s):  
Timolaos Rizos ◽  
Andreas J. Bartsch ◽  
Timothy D. Johnson ◽  
Felix Dittgen ◽  
Thomas E. Nichols ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Newly Diagnosed

scholarly journals Assessment of Atrial Conduction Times in Patients with Newly Diagnosed Parkinson’s Disease

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Yiğit Çanga ◽  
Ayşe Emre ◽  
Gülbün Asuman Yüksel ◽  
Mehmet Baran Karataş ◽  
Nizamettin Selçuk Yelgeç ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Ischemic Stroke ◽  
Electromechanical Coupling ◽  
P Wave ◽  
Volume Index ◽  
Newly Diagnosed ◽  
Increased Risk ◽  
Atrial Conduction Times

Background. An increased risk of ischemic stroke has been reported in patients with Parkinson’s disease (PD). Atrial fibrillation (AF) is strongly associated with ischemic stroke. Prolonged atrial electromechanical delay (EMD) is an independent predictor for the development of AF. Aims. The aim of the present study was to evaluate the atrial conduction parameters in patients with PD and to assess their relation with the severity of PD. Study design. We prospectively enrolled 51 consecutive patients with newly diagnosed PD and 31 age- and sex-matched non-PD subjects. Methods. To assess atrial electromechanical coupling (PA), the time intervals from the onset of p wave on ECG to the late diastolic wave at the septal (PAs) and lateral (PAl) mitral annulus and lateral tricuspid annulus (PAt) were measured on Tissue Doppler Echocardiography (TDE). The difference between PAs-PAl, PAs-PAt, and PAl-PAt were defined as left intra-atrial, right intra-atrial, and interatrial EMD, respectively. P-wave dispersion (PWD) was calculated from the 12-lead ECG. Results. PWD, PAs, PAl, and PAt durations were significantly prolonged in the PD group (all p<0.001). Interatrial, right, and left intra-atrial EMD were also significantly longer in PD patients (p<0.001, p<0.001 and p=0.002, resp.). There were significant positive correlations between disease severity (UPDRS score) and PWD (r=0.34, p=0.041), left intra-atrial (r=0.39, p=0.005), and interatrial EMD (r=0.35, p=0.012). By multivariate analysis, PWD (OR: 1.13, 95% CI: 1.02–1.25; p=0.017), LA volume index (OR: 1.19, 95% CI: 1.02–1.37; p=0.021), left intra-atrial (OR: 1.12, 95% CI: 1.01–1.24; p=0.041), and interatrial EMD (OR: 1.08, 95% CI: 1.01–1.16; p=0.026) were found as independent predictors of PD. Conclusion. Atrial conduction times were longer and correlated with the severity of disease in PD patients. Prolonged inter- and intra-atrial-EMD intervals were also found as independent correlates of PD. These findings may suggest an increased predisposition to atrial fibrillation in PD.

scholarly journals Risk of Ischemic Stroke in Patients Newly Diagnosed With Heart Failure: Focus on Patients Without Atrial Fibrillation

2019 ◽  
Vol 25 (6) ◽  
pp. 436-447 ◽  
Author(s):  
Jeffrey S. Berger ◽  
Eric Peterson ◽  
François LalibertÉ ◽  
Guillaume Germain ◽  
Dominique Lejeune ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Newly Diagnosed

Abstract WP255: Can Normal Electrocardiogram Rule Out Newly Diagnosed Atrial Fibrillation in Ischemic Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Joshua Santucci ◽  
Takashi Shimoyama ◽  
Ken Uchino
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cryptogenic Stroke ◽  
Cardiac Monitoring ◽  
Large Artery ◽  
Newly Diagnosed ◽  
Stroke Patients ◽  
Stroke Subtype ◽  
History Of

Introduction: Electrocardiogram (ECG) findings of premature atrial contraction and prolonged PR interval are associated with risk of onset atrial fibrillation (AF) in cryptogenic stroke. We sought to see if normal ECG and AF incidence is incompletely understood. Methods: From a prospective single-hospital stroke registry from 2018, we identified ischemic stroke patients who had ECG done on admission for review. We excluded patients with AF on admission ECG, history of AF, and implanted device with cardiac monitoring capability. Normal ECG was interpreted based on the standardized reporting guidelines for ECG studies evaluating risk stratification of emergency department patients. Stroke subtype was diagnosed according to the TOAST classification: large artery atherosclerosis (LAA), small vessel occlusion (SVO), cardioembolism, others/undetermined and embolic stoke of undetermined source (ESUS) criteria. We compared the incidence of newly diagnosed AF during hospitalization and from outpatient cardiac event monitoring between normal and abnormal ECG. Results: Of the 558 consecutive acute ischemic stroke patients, we excluded 135 with AF on admission ECG or history of AF and 9 with implanted devices. Of the remaining 414 patients that were included in the study, ESUS (31.2%) was the most frequent stroke subtype, followed by LAA (30.0%), SVO (14.0%), others/undetermined (15.7%), and cardioembolism (9.2%). Normal ECG was observed in 125 patients (30.2%). Cardioembolic subtype was less frequent in the normal versus abnormal ECG group (1.6% vs. 12.5%, p<0.001). New AF was detected in 17/414 patients (4.1%) during hospitalization. Of these 17 patients, none had normal ECG (0/125) and all had abnormal ECG (17/289, 5.9%) (p=0.002). After discharge, of 111 patients undergoing 4-week outpatient cardiac monitoring, new AF was detected in 16 (14.4%). Of these 16 patients, only 1 had a normal ECG (1/35, 2.9%) while 15 had abnormal ECG (15/76, 19.7%) (p=0.02). Conclusions: Normal ECG at admission for acute ischemic stroke is associated with low likelihood of detection of new atrial fibrillation in either the inpatient or outpatient setting.

Abstract TP196: Incident Atrial Fibrillation After Ischemic versus Hemorrhagic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jens Witsch ◽  
Alexander E Merkler ◽  
Gino Gialdini ◽  
Babak B Navi ◽  
Kevin N Sheth ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Heart Rhythm ◽  
Cox Proportional Hazards ◽  
Sensitivity Analyses ◽  
Newly Diagnosed ◽  
Post Discharge ◽  
Discharge Disposition ◽  
Rhythm Monitoring

Background: Atrial fibrillation (AF) is often newly diagnosed during heart-rhythm monitoring after ischemic stroke. It is unclear what proportion of these AF cases represent pre-existing disease and what proportion are triggered by stroke itself. Vascular brain injury that is either ischemic or hemorrhagic may be associated with subsequent AF. Objective: To compare the incidence of newly diagnosed AF after ischemic versus hemorrhagic stroke. Methods: We performed a retrospective cohort study using inpatient and outpatient claims data from a 5% sample of Medicare beneficiaries. We included all patients hospitalized with ischemic or hemorrhagic stroke (intracerebral or subarachnoid hemorrhage) from 2009-2014. Patients with any AF diagnosis before or during the index stroke hospitalization were excluded. The primary outcome was an incident diagnosis of AF. All variables were defined using previously validated ICD-9-CM diagnosis codes. Kaplan-Meier survival statistics were used to calculate cumulative rates of AF. Cox proportional hazards analysis was used to determine the association between stroke subtype and incident AF while adjusting for demographics, vascular risk factors, discharge disposition, and whether any post-discharge heart-rhythm monitoring was performed. We performed sensitivity analyses excluding patients with any post-discharge heart-rhythm monitoring and adjusting for the total number of post-stroke follow-up visits. Results: We identified 38,947 patients with ischemic stroke and 5,133 patients with hemorrhagic stroke. By 5 years, the cumulative rate of AF was 23.9% (95% confidence interval [CI], 23.2-24.7%) in patients with ischemic stroke versus 15.5% (95% CI, 13.8-17.3%) in those with hemorrhagic stroke. After adjusting for potentially confounding factors, patients with ischemic stroke were more likely to develop incident AF (hazard ratio, 1.3; 95% CI, 1.1-1.4). This association remained unchanged in our sensitivity analyses. Conclusions: New AF diagnoses are common after hemorrhagic stroke but even more common after ischemic stroke. Our findings suggest that AF found on heart-rhythm monitoring after ischemic stroke represents a mix of both pre-existing disease and stroke-induced dysrhythmia.

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