Neurologic events in patients with atrial fibrillation: outcome and prevention practices

Background: Atrial fibrillation (AF) is associated with neurologic events ( transient ischemic attack (TIA) and stroke). The objective of the present s tudy was to determine the outcome of patients with neurological events and atrial fibrillation (AF) in comparison with patients in sinus rhythm (SR), and to investigate the primary and secondary prevention practices in patien ts with neurological events and AF. Patients and methods: In a prospective, observational, single center study in a large public, university-affiliated hospital all patients admitted bet ween 1/97 and 1/98 with acute neurologic events were registered (n = 369). The association between outcome of neurologic events as assessed by surviva l status, functional status (Rankin scale) and severity of event (European Stroke Scale) and heart rhythm was investigated by use of logistic regressi on. Antithrombotic medication on admission and at discharge was recorded. Results: The mean age of the 369 patients was 75.1+/-10.9 years; 56.1% were female. A TIA was present in 26.2% and stroke in 73.8%. 287 patients (77.8 %) were in SR and 82 in AF on admission (22.2%). In-hospital mortality was 12.7% in all patients. In patients with AE mortality was 23.2% and 9.8% in patients with SR (p = 0.0013). Patients with AF were significantly older th an patients with SR (80.4+/-7.5 versus 73.5+/-11.2 years; p<0.001). Multiva riate analysis identified heart rhythm as an independent predictor of survi val (p<0.01). Patients with AF did suffer from a more severe neurological d eficit on admission and at discharge than patients with SR. In 46.3% of pat ients with AF severe dependency was present (Rankin 4/5), while this was th e case in 28.5% of patients with SR (p<0.01). The ESS score of patients wit h AF was 77.4+/-30.6 at discharge compared to 88.1+/-20.3 in patients with SR (p<0.01). In 50 of 82 patients (61%) AF was previously known. Of these 50 patients 36 % did not receive any kind of antithrombotic treatment and only 12% were re ceiving oral anticoagulants before the event. Of 63 surviving patients with AF 32 did not have any contraindications against anticoagulation treatment . At discharge, 14 (43.8%) of these patients were receiving oral anticoagul ants, 17 aspirin or ticlopidine (53.1%) and 1 patient (3.1%) no type of ant ithrombotic medication. Conclusions: Neurologic events in patients with AF are more severe and outc ome is significantly poorer than in patients with SR. Anticoagulation as th e effective therapy for primary and secondary prevention of neurologic even ts is seriously underused in daily practice.