ATRIAL-FIBRILLATION AND STROKE - MORTALITY AND CAUSES OF DEATH AFTER THE FIRST ACUTE ISCHEMIC STROKE

Background and Purpose Atrial fibrillation (AF) is a risk factor for s troke. This study was undertaken to determine the influence of AF on t he mortality of stroke patients and on the causes of death after a str oke event. Methods Patients with first ischemic stroke who were 35 to 74 years old and registered in the FINMONICA stroke register during 19 82 through 1992 were analyzed (n=6912). There were 642 patients with A F (9.3%) (mean age, 67 years) and 6270 patients without AF (90.3%) (me an age, 63 years). The association between AF and stroke mortality was investigated by use of logistic regression and Cox proportional hazar ds models. Results Mortality was higher in the AF group both at 28 day s (19.5% versus 14.4%, P<.001) and 1 year after the attack (30.5% vers us 21.8%, P<.001). After adjustment for age and sex, the odds ratio fo r 28-day case fatality (AF versus non-AF) was 1.27 (95% CI, 1.03 to 1. 56; P=.003), and that for 1-year mortality was 1.36 (95% CI, 1.14 to 1 .63; P<.001). In the proportional hazards model, AF was a significant independent risk factor for 1-year mortality (hazard ratio, 1.26; 95% CI, 1.09 to 1.46; P=.002). Cardiac causes of death were more common in the AF group at the acute stage. In the course of 1 year, there were no differences in the distributions of causes of death. Conclusions St roke patients with AF are at high risk of death both at the acute phas e of stroke and during the subsequent year after the first acute strok e event. Mortality from cardiac diseases prevailed in the AF group dur ing the acute phase of stroke. Careful cardiac evaluation and treatmen t are essential in patients with AF and stroke.