ACUTE STROKE WITH ATRIAL-FIBRILLATION - THE COPENHAGEN STROKE STUDY

Background Atrial fibrillation (AF) is a common arrhythmia and a major risk factor for stroke. Many physicians remain reluctant to provide s troke prevention by anticoagulant therapy especially for elderly indiv iduals with AF. Using multivariate regression analyses, we studied the characteristics and the prognosis of stroke in patients with AF. Meth ods The study is part of the Copenhagen Stroke Study, a prospective, c ommunity-based study of 1197 patients with acute stroke treated on a s troke unit from the time of acute admission to the end of rehabilitati on. Initial stroke severity was measured by the Scandinavian Neurologi cal Stroke Scale (SSS). Neurological and functional outcomes were eval uated by the SSS and the Barthel Index. Results AF was diagnosed in 18 % of the patients. AF increased steeply with age in the stroke populat ion, from 2% in patients <50 years old, 15% in patients in their 70s, and 28% in patients in their 80s, to 40% in patients greater than or e qual to 90 years of age. In a multivariate analysis AF was associated with age (odds ratio [OR], 2.0 per 10-year increase; 95% confidence ra tio [CI], 1.6 to 2.6), ischemic heart disease (OR, 3.4; 95% CI, 2.4 to 4.8), previous stroke (OR, 1.8; 95% CI, 1.2 to 2.6), and systolic blo od pressure (OR, 0.93 per 10-mm Hg increase; 95% CI, 0.88 to 0.99), bu t not with sex, diabetes, hypertension, previous transient ischemic at tack, or silent infarction on computed tomography. Patients with AF ha d a higher mortality rate (OR, 1.7; 95% CI, 1.2 to 2.5), longer hospit al stays (50 days versus 40 days, P<.001), and a lower discharge rate to their own homes (OR, 0.60; 95% CI, 0.44 to 0.85). Neurological and functional outcomes were markedly poorer in patients with AF. Poorer o utcome was exclusively explained by initially more-severe strokes. Con clusions Stroke in patients with AF is generally more severe and outco me markedly poorer than in patients with sinus rhythm. This accentuate s the importance of anticoagulant treatment of individuals with AF. A lower blood pressure in the acute stage of stroke may contribute to th e increased stroke severity in patients with AF.