PREVALENCE OF ATRIAL-FIBRILLATION AND ASSOCIATION OF ATRIAL-FIBRILLATION WITH PRIOR AND NEW THROMBOEMBOLIC STROKE IN OLDER PATIENTS

OBJECTIVE: To correlate atrial fibrillation with the incidence of new thromboembolic (TE) stroke in older patients with and without prior TE stroke. DESIGN: In a prospective study of 2101 older patients, electr ocardiograms showed that atrial fibrillation was present in 283 patien ts (13%). At 42-month mean follow-up, atrial fibrillation was associat ed with the incidence of new TE stroke in patients with and without pr ior TE stroke. SETTING: A large long-term health care facility where 2 101 older patients were studied. PATIENTS: The 2101 patients included 1451 women and 650 men, mean age 81 +/- 8 years (range 60 to 103). MEA SUREMENTS AND MAIN RESULTS: Atrial fibrillation was present in 283 of 2101 patients (13%). The mean age was 84 +/- 7 years in patients with atrial fibrillation and 81 +/- 8 years in patients with sinus rhythm ( P = .0001). The prevalence of atrial fibrillation was 5% in patients a ged 60 to 70 years, 14% in patients aged 71 to 80 years, 13% in patien ts aged 81 to 90 years, and 22% in patients aged 91 to 103 years (P < .0001). Mean follow-up was 31 +/- 18 months in patients with atrial fi brillation and 44 +/- 27 months in patients with sinus rhythm (P = .00 01). Previous TE stroke occurred in 123 of 283 patients (43%) with atr ial fibrillation and in 431 of 1818 patients (24%) with sinus rhythm ( P < .0001). New TE stroke occurred in 131 of 283 patients (46%) with a trial fibrillation and in 303 of 1818 patients (17%) with sinus rhythm (P < .0001). The log-rank test showed that patients with atrial fibri llation had a significantly higher probability of developing new TE st roke than those with sinus rhythm (P < .0001). The multivariate Cox re gression model showed that independent risk factors for new TE stroke were male sex (relative risk = 1.3), prior TE stroke (relative risk = 3.1), and atrial fibrillation (relative risk = 3.3). CONCLUSIONS: Atri al fibrillation, prior TE stroke, and male sex are independent risk fa ctors for the development new TE stroke in older patients.