Recurrent Stroke Risk in Pilots with Atrial Fibrillation

2020 ◽  
Vol 91 (4) ◽  
pp. 352-357
Author(s):  
Jessica Tedford ◽  
Valerie Skaggs ◽  
Ann Norris ◽  
Farhad Sahiar ◽  
Charles Mathers
Keyword(s):  
Atrial Fibrillation ◽  
General Population ◽  
Recurrent Events ◽  
Stroke Risk ◽  
Event Rate ◽  
Recurrent Stroke ◽  
Previous History ◽  
Recurrent Event ◽  
Recurrence Rates ◽  
Medical Certification

INTRODUCTION: Atrial fibrillation (AF) is one of the most common cardiac arrhythmias in the general population and is considered disqualifying aeromedically. This study is a unique examination of significant outcomes in aviators with previous history of both AF and stroke.METHODS: Pilots examined by the FAA between 2002 and 2012 who had had AF at some point during his or her medical history were reviewed, and those with an initial stroke or transient ischemic attack (TIA) during that time period were included in this study. All records were individually reviewed to determine stroke and AF history, medical certification history, and recurrent events. Variables collected included medical and behavior history, stroke type, gender, BMI, medication use, and any cardiovascular or neurological outcomes of interest. Major recurrent events included stroke, TIA, cerebrovascular accident, death, or other major events. These factors were used to calculate CHA2DS2-VASc scores.RESULTS: Of the 141 pilots selected for the study, 17.7% experienced a recurrent event. At 6 mo, the recurrent event rate was 5.0%; at 1 yr, 5.8%; at 3 yr 6.9%; and at 5 yr the recurrent event rate was 17.3%. No statistical difference between CHA2DS2-VASc scores was found as it pertained to number of recurrent events.DISCUSSION: We found no significant factors predicting risk of recurrent event and lower recurrence rates in pilots than the general population. This suggests CHA2DS2-VASc scores are not appropriate risk stratification tools in an aviation population and more research is necessary to determine risk of recurrent events in aviators with atrial fibrillation.Tedford J, Skaggs V, Norris A, Sahiar F, Mathers C. Recurrent stroke risk in pilots with atrial fibrillation. Aerosp Med Hum Perform. 2020; 91(4):352–357.

Abstract T MP104: The Role of Antithrombotics Therapy in Recent Ischaemic Stroke Patients with Atrial Fibrillation: Analysis from VISTA

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Azmil H Abdul-Rahim ◽  
Rachael L Fulton ◽  
Frank Benedikt ◽  
Turgut Tatlisumak ◽  
Maurizio Paciaroni ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischaemic Stroke ◽  
Recurrent Stroke ◽  
Previous History ◽  
Neurological Impairment ◽  
Antithrombotic Treatment ◽  
Risk Of Mortality ◽  
Natural Progression ◽  
Increased Risk ◽  
History Of

Background and Purpose: There is uncertainty on the optimal latency after acute ischaemic stroke at which antithrombotic treatment should commence for atrial fibrillation (AF) patients, in order to prevent recurrent stroke (RS) without provoking symptomatic intracranial haemorrhage (SICH). We sought to describe the risk factors and patterns of RS and SICH in a cohort of patients with AF and recent stroke. Methods: We assessed the association of antihrombotic treatment (i.e. anticoagulants and antiplatelets) with the distribution of the modified Rankin Scale (mRS) at day 90, and the occurrence of RS and SICH. We developed statistical models for the prediction of RS and SICH in the first 90 days after stroke, using univariate and multivariate analysis. Results: Data were available for 1,644 patients. Combined antithrombotic therapy with both anticoagulation and antiplatelet (n=782) was associated with more favourable functional outcome across full scale mRS OR=1.785 (95% CI: 1.316, 2.421; P=0.0002), and significantly lower risk of mortality by day 90, SICH by day 90 and RS by day 90: Mortality day 90 OR=0.344 (95% CI: 0.235, 0.502; P<0.0001), SICH day 90 OR=0.18 (95% CI: 0.086, 0.37; P<0.0001) and RS day 90 OR=0.33 (95% CI: 0.21, 0.53; P<0.0001). Patients with ischaemic stroke who had high baseline glucose had a high risk of both RS and SICH events after stroke. Additionally, patients who had increased neurological impairment, previous history of TIA and received no antithrombotic treatment were at increased risk of RS. The relative risk of RS versus SICH appeared constant over time. Conclusions: It seems justified to initiate anticoagulation immediately the patient attains medical and neurological stability, taking into account the potential of haemorrhagic transformation as part of the natural progression in stroke and the increasing risk of recurrent stroke with time if left untreated. Antiplatelet treatment pending introduction of anticoagulation is reasonable.

scholarly journals Atrial Fibrillation and Stroke Risk in Patients With Cancer: A Primer for Oncologists

2019 ◽  
Vol 15 (12) ◽  
pp. 641-650 ◽  
Author(s):  
Marc Sorigue ◽  
Milos D. Miljkovic
Keyword(s):  
Atrial Fibrillation ◽  
General Population ◽  
Stroke Risk ◽  
Bleeding Risk ◽  
Initial Therapy ◽  
Decision Algorithm ◽  
Patients With Cancer ◽  
Risk Of Bleeding ◽  
Risk For Bleeding ◽  
Quality Evidence

Cancer and atrial fibrillation (AF) are common conditions, but for patients affected with both, there is a lack of data about management of anticoagulation and cerebrovascular outcomes. In the first section of this review, we summarize the most relevant studies on stroke risk and management of AF in patients with active cancer, attempting to answer questions of whether to anticoagulate, whom to anticoagulate, and what agents to use. In the second section of the review, we suggest a decision algorithm on the basis of the available evidence and provide practical recommendations for each of the anticoagulant options. In the third section, we discuss the limitations of the available evidence. On the basis of low-quality evidence, we find that patients with cancer and AF have a risk of stroke similar to that of the general population but a substantially higher risk of bleeding regardless of the anticoagulant agent used; this makes anticoagulation-related decisions complex and evidence from the general population not immediately applicable. In general, we suggest stopping anticoagulation in patients with high risk of bleeding and in those with a moderate bleeding risk without a high thromboembolic risk and recommend anticoagulation as in the general population for patients at a low risk for bleeding. However, regardless of initial therapy, we recommend reassessing whether anticoagulation should be given at each point in the clinical course of the disease. High-quality evidence to guide anticoagulation for AF in patients with cancer is needed.

scholarly journals Statin Adherence Is Associated With Reduced Recurrent Stroke Risk in Patients With or Without Atrial Fibrillation

Stroke ◽  
2017 ◽  
Vol 48 (7) ◽  
pp. 1788-1794 ◽  
Author(s):  
Alexander C. Flint ◽  
Carol Conell ◽  
Xiushui Ren ◽  
Hooman Kamel ◽  
Sheila L. Chan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Statin Adherence

scholarly journals Unrecognized History of Transient Atrial Fibrillation at the Time of Discharge from an Index Stroke Hospitalization Is Associated with Increased Recurrent Stroke Risk

2019 ◽  
Vol 21 (2) ◽  
pp. 190-194
Author(s):  
Chia-Yu Hsu ◽  
Daniel E. Singer ◽  
Hooman Kamel ◽  
Yi-Ling Wu ◽  
Pei-Chun Chen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Index Stroke ◽  
History Of

A New Arrhythmia

2016 ◽  
Author(s):  
Ji Y. Chong ◽  
Michael P. Lerario
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Lower Risk ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Oral Anticoagulants ◽  
Novel Oral Anticoagulants ◽  
Bleeding Complications ◽  
The Novel ◽  
Risk Of Bleeding

Atrial fibrillation is a potent risk factor for stroke. Anticoagulation significantly lowers recurrent stroke risk in patients with atrial fibrillation. The novel oral anticoagulants offer options in addition to warfarin, and they are associated with lower risk of bleeding complications.

Abstract W MP72: Sleep and Timing of Recurrent Events in a Mild Stroke Population: Results of the SWIFT Study

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Eric Roberts ◽  
Leigh Quarles ◽  
Veronica Torrico ◽  
Bernadette Boden-Albala
Keyword(s):  
Recurrent Events ◽  
Sleep Problems ◽  
Recurrent Stroke ◽  
Recurrent Event ◽  
P Value ◽  
Shortness Of Breath ◽  
Vascular Events ◽  
Cox Models ◽  
Stroke Population ◽  
Index 2

Sleep is an important contributor to cardiovascular disease; we have previously reported it is a risk factor for incident vascular events. It is thought that sleep apena may be the primary mechanism through which sleep disturbance is associated with vascular events. Little is known, however, about the association between sleep and recurrent events. The aim of this analysis was to determine the association between sleep problems and the risk of recurrent vascular events in an elderly, multiethnic population. This analysis uses data from SWIFT, a randomized clinical trial conducted in northern Manhattan designed to test a stroke preparedness intervention. Sleep was measured with the MOS sleep scale. MOS is a 12 item questionnaire that produces 8 validated scales. We report results using the snoring (1 question), shortness of breath during sleep (1 question), and sleep problem index 2 (9 questions) scales. Outcomes were collected prospectively through active surveillance. We used Cox Models to test whether our measures of sleep were associated with an increased hazard of having a recurrent event. SWIFT randomized 1193 stroke participants: mean age 63 years +- 15.14; 50% female; 17% black, 51% Hispanic, 26% white, 6% other. In models adjusted for treatment assignment, race, age, gender, education, marital status and baseline measures of hypertension, diabetes, smoking and NIH stroke scale the sleep problems index 2 was associated with an increased hazard of a first recurrent stroke or TIA (HR=1.91, p-value=0.02), whereas our measures of snoring (HR=1.20, p-value=0.43) and shortness of breath during sleep (HR=1.39, p-value=0.46) were not. The same pattern of results held for a composite measure of first recurrent stroke, TIA, MI or vascular death: sleep problems index 2 (HR=1.97, p-value=0.003), snoring (HR=1.10, p-value=0.62) and shortness of breath during sleep (HR=1.59, p-value=0.18). Our results highlight the contribution of sleep to the risk of recurrent vascular events in a population of mild and moderate stroke/TIA survivors. Importantly, this result is not driven by snoring or trouble breathing at night and is independent of hypertension, smoking and diabetes.

scholarly journals Prediction of recurrent stroke among ischemic stroke patients with atrial fibrillation: Development and validation of a risk score model

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258377
Author(s):  
Beom Joon Kim ◽  
Keon-Joo Lee ◽  
Eun Lyeong Park ◽  
Kanta Tanaka ◽  
Masatoshi Koga ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Prediction Model ◽  
Risk Prediction ◽  
Recurrent Events ◽  
Recurrent Stroke ◽  
External Validation ◽  
Risk Prediction Model ◽  
Validation Dataset ◽  
Stroke Recurrence

Background There is currently no validated risk prediction model for recurrent events among patients with acute ischemic stroke (AIS) and atrial fibrillation (AF). Considering that the application of conventional risk scores has contextual limitations, new strategies are needed to develop such a model. Here, we set out to develop and validate a comprehensive risk prediction model for stroke recurrence in AIS patients with AF. Methods AIS patients with AF were collected from multicenter registries in South Korea and Japan. A developmental dataset was constructed with 5648 registered cases from both countries for the period 2011‒2014. An external validation dataset was also created, consisting of Korean AIS subjects with AF registered between 2015 and 2018. Event outcomes were collected during 1 year after the index stroke. A multivariable prediction model was developed using the Fine–Gray subdistribution hazard model with non-stroke mortality as a competing risk. The model incorporated 21 clinical variables and was further validated, calibrated, and revised using the external validation dataset. Results The developmental dataset consisted of 4483 Korean and 1165 Japanese patients (mean age, 74.3 ± 10.2 years; male 53%); 338 patients (6%) had recurrent stroke and 903 (16%) died. The clinical profiles of the external validation set (n = 3668) were comparable to those of the developmental dataset. The c-statistics of the final model was 0.68 (95% confidence interval, 0.66 ‒0.71). The developed prediction model did not show better discriminative ability for predicting stroke recurrence than the conventional risk prediction tools (CHADS2, CHA2DS2-VASc, and ATRIA). Conclusions Neither conventional risk stratification tools nor our newly developed comprehensive prediction model using available clinical factors seemed to be suitable for identifying patients at high risk of recurrent ischemic stroke among AIS patients with AF in this modern direct oral anticoagulant era. Detailed individual information, including imaging, may be warranted to build a more robust and precise risk prediction model for stroke survivors with AF.

Delayed diagnosis of atrial fibrillation after first-ever stroke increases recurrent stroke risk: a 5-year nationwide follow-up study

2018 ◽  
Vol 48 (6) ◽  
pp. 661-667 ◽  
Author(s):  
Ping-Song Chou ◽  
Bo-Lin Ho ◽  
Yi-Hsin Chan ◽  
Min-Hsien Wu ◽  
Han-Hwa Hu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Delayed Diagnosis ◽  
Follow Up Study

scholarly journals Treatment of cryptogenicstroke patients with atrial fibrillation detected by insertable cardiac monitors reduces recurrent stroke risk to background levels

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Kloosterman ◽  
M.R Rosenbaum ◽  
E.J.B Berkowitz ◽  
N.K Kloosterman ◽  
J Rosman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulation ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Cryptogenic Stroke ◽  
Stroke Rate ◽  
Stroke Patients ◽  
Background Levels ◽  
Significant Difference ◽  
Recurrent Strokes

Abstract Background Atrial fibrillation (AF) is a well-known risk factor for ischemic stroke with a reported increased incidence range of 2.5 to 5-fold. However, it is not well established whether treatment of cryptogenic stroke patients with AF detected by insertable cardiac monitors (ICM) reduces the risk of recurrent stroke. Objective To compare recurrent stroke rates between cryptogenic stroke patients who have AF detected by ICMs and thus started on oral anticoagulation (OAC) treatment and those without detected AF. Methods We performed a retrospective analysis of consecutive patients who received an ICM for the purpose of AF monitoring following a cryptogenic stroke between July 2015 and March 2019. Patients with prior documented AF history were excluded. We calculated the rates of AF detection and OAC initiation. We also compared recurrent stroke rates between patients with and without AF detected. Results A total of 298 cryptogenic stroke patients receiving an ICM and home remote monitoring were studied (mean age: 77 SD: 11.7; Female/Male: 147 (49%)/151; virtual CHA2DS2-VASc: 4.96 SD: 1.28). AF was newly detected in 91 (29.6%) patients over a mean follow-up of 46 months. Of these patients 68 (72.4%) were started on OAC, 12 (15.3%) were already on OAC and 11 (12.2%) remained not anticoagulated. Of the total patients evaluated, 22 patients (7.3%) developed recurrent strokes for an annualized stroke rate of 1.926%. Of those, 8 occurred among the 91 patients with newly detected AF, for an annualized stroke rate of 1.72%. The remining 14 recurrent strokes occurred among the 207 patients without AF detected, for an annualized stroke rate of 1.76%; (p=0.87). One recurrent stroke occurred in an AF patient not anticoagulated due to a prior bleeding event. No hemorrhagic strokes were reported in the AF-OAC group. Conclusion Our study found that newly AF was detected by ICM in almost 1/3 (29%) of cryptogenic stroke patients (consistent with previous studies), and the vast majority of them (88%) accordingly received oral anticoagulation. There was not a significant difference in recurrent stroke rates among patients with AF detected on OAC and those without AF detected. This suggests that rigorous arrhythmia monitoring with ICMs can help identify cryptogenic stroke patients with new AF and initiate oral anticoagulation accordingly, to reduce their risk of recurrent stroke to background levels. Annualized Stroke Risk Funding Acknowledgement Type of funding source: None

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