Stroke May Be the First Sign of Atrial Fibrillation

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The researchers assessed 1809 patients with incidence of stroke and atrial fibrillation.
The researchers assessed 1809 patients with incidence of stroke and atrial fibrillation.

While an uncommon first manifestation of atrial fibrillation (AF), stroke can effectively indicate AF's presence, according to research published in Stroke.

Stephen A. Lubitz, MD, MPH, of the Cardiac Arrhythmia Service and Cardiovascular Research Center at Massachusetts General Hospital in Boston, and colleagues studied the link between stroke and AF using data collected from the Framingham Heart Study. The researchers colleagues focused on incident strokes occurring ≤1 year prior to onset of AF.

The study included 1809 patients with incident AF between 1951 and 2013 (mean age at AF detection: 74.6 ± 11.2 years; 47% women). Among all patients, 87 (4.8%) strokes occurred ≤1 year before detection of AF; 94% were ischemic strokes. Nearly 2% of patients had strokes that occurred on the day that AF was first detected; 3.4% occurred within 30 days of AF detection, and 3.7% occurred within 90 days. The researchers noted that results were not different when restricting data to ischemic strokes.

“By extrapolating these observations, we estimate that for both men and women, approximately 2 to 5 individuals per 10,000 person-years may present with stroke as the initial manifestation of AF,” the researchers concluded. “The utility and cost effectiveness of efforts to reduce stroke by identifying individuals with undiagnosed AF require prospective evaluation.”

Study Limitations

  • The frequency of AF-associated stroke may have been underestimated if the strokes were fatal, if AF was unrecognized, or if AF occurred as an isolated episode.
  • Strokes occurring >365 days before an AF event may be related to an undetected arrhythmia.
  • The study sample comprised predominantly people of European ancestry; therefore, findings may not be generalizable to other racial or ethnic groups.
  • Era-specific factors may have influenced the probability of AF and stroke detection.
  • Some AF events may be a consequence of stroke, rather than causally related to stroke.

Disclosures: Dr Lubitz reports receiving consulting support from St. Jude Medical and grant funding from Boehringer Ingelheim. Dr Ellinor reports receiving grant funding from Bayer HealthCare and consulting support from Quest Diagnostics. Dr McManus reports receiving grant and/or consulting funding from Samsung Electronics, Philips Healthcare, Bristol Myers-Squibb, and Pfizer, and is an equity stakeholder in Mobile Sense Technologies, Inc.

Reference

Lubitz SA, Yin X, McManus DD, et al. Stroke as the initial manifestation of atrial fibrillation [published online January 12, 2017]. Stroke. doi: 10.1161/strokeaha.116.015071

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