Abstract 19468: Timing of Atrial Fibrillaiton-related Stroke and the Risk of All-cause Mortality
Introduction: Strokes that occur after the onset of atrial fibrillation (AF) have a worse prognosis than strokes that do not occur in the setting of AF. Recent studies suggest that strokes that occur within several months prior to an AF diagnosis may be related to underlying, silent AF. Limited studies have evaluated survival differences between AF-related strokes that occur prior versus after AF diagnosis.
Objective: We evaluated differences in the risk of all-cause death between patients that develop stroke in the 6 months before compared to any time after the diagnosis of AF.
Methods: We utilized the University of Pennsylvania AF Free study to create an inception cohort of patients with incident stroke and AF. We assessed ECGs, clinical records, and administrative data within the health system over a 5 year period to identify individuals that had a first diagnosis of stroke or AF. Cox proportional hazards models evaluated associations between stroke subtypes and death.
Results: We identified 3,616 individuals that developed stroke (323 had stroke after AF diagnosis, 292 patients had stroke within 6 months preceding AF diagnosis, and 2795 patients had stroke without an AF diagnosis). Of these patients, there were 319 all-cause mortality events over a median 4.6 [3.8, 5.5] years follow-up. The overall mortality rate was highest in patients that had a stroke within 6 months prior to AF (Table 1) and was almost 2-fold higher than those that had a stroke after an AF diagnosis (p<0.001). After multivariable adjustment, patients with an AF-related stroke that occurred within 6-months prior to the diagnosis of AF had a significantly higher risk of death than those with stroke that occurred after an AF diagnosis or those with stroke but no AF (Table 1).
Conclusions: Stroke that occurs prior to the diagnosis of AF was associated with a significantly higher risk of all-cause death. This increased mortality risk is not explained by the presence of other comorbid conditions.
Author Disclosures: P.J. Patel: None. R. Katz: None. J.J. Liang: None. S. Dixit: Honoraria; Significant; Biosense Webster, SJM, Biotronik. D.J. Callans: None. A.E. Epstein: Research Grant; Significant; Biotronik, Boston Scientific, Medtronic, St Jude Medical. Honoraria; Significant; Boston Scientific, Medtronic, St Jude Medical. Consultant/Advisory Board; Significant; Boston Scientific, Medtronic, St Jude Medical, Zoll. Other; Significant; Fellowship support from Biotronik, Bostton Scientific, Medtronic, St Jude Medical. F.E. Marchlinski: None. R. Deo: None.
- © 2015 by American Heart Association, Inc.