Abstract 2786: Risk and Contributing Factors of Stroke Recurrence In Patients Newly Diagnosed With Atrial Fibrillation
Background: Atrial fibrillation (AF) is potent risk factor for ischemic stroke. We recently reported the incidence and risk factors associated with first stroke amongst patients newly diagnosed with AF. The data regarding risk of and factors contributing to recurrent stroke amongst these patients are sparse.
Methods: The medical records for residents of Olmsted County, Minnesota, with an ECG-confirmed diagnosis of first AF between 1980 and 2000 were reviewed, and followed forward to 2004. The sex-specific incidence of recurrent ischemic stroke was evaluated. Cox proportional hazards modeling was used to assess the predictors for recurrent stroke and subsequent mortality risk.
Results: Of the 4,117 subjects (72 ± 15 years old, 51% men) diagnosed with first AF and without prior stroke, 446 (11%) sustained at least one ischemic stroke during a mean follow up time of 5.5 ± 5.0 years. Of the 446 patients (81 ± 10 years old, 38% men), 46 (10%) developed recurrent ischemic stroke during a mean follow up of 2.7 ± 3.3 years, and 363 died. The unadjusted incidence of recurrent stroke was 42/1000 person-years, with no difference between men and women even after adjusting for age and comorbid conditions (P=0.83). Cox multivariate analyses showed that a history of congestive heart failure (CHF) was the only significant independent predictor for recurrent ischemic stroke (HR=2.9, 95% CI 1.6–5.4, P< 0.001). Recurrent ischemic stroke was strongly predictive of death (HR=1.8, 95% CI 1.3–2.5, P=0.001), even after adjusting for age, sex, and comorbid conditions (HR=1.9, 95% CI 1.3–2.6, P<0.001)(Table⇓). There was no gender difference in the excess risk of death following recurrent stroke.
Conclusions: AF patients who sustained a first stroke were at markedly increased risk of recurrent stroke which was strongly associated with death. CHF appeared to be a potent marker for stroke recurrence.