Abstract
Background and Purpose: Recent evidence suggests that patients with atrial fibrillation (AF) detected after stroke ( AFDAS ) may have a lower prevalence of cardiovascular comorbidities and lower risk of stroke recurrence than AF known before stroke ( KAF ). We performed a systematic search and meta-analysis to compare the characteristics of AFDAS and KAF. Methods: We searched PubMed, Scopus, and EMBASE for articles reporting differences between AFDAS and KAF until 30-June-2021. We performed random- or fixed-effects meta-analyses to evaluate differences between AFDAS and KAF in demographic factors, vascular risk factors, prevalent vascular comorbidities, structural heart disease, stroke severity, insular cortex involvement, stroke recurrence, and death. Results: We included 21 studies comprising 22,566 patients with ischemic stroke or transient ischemic attack. Patients with AFDAS had a lower CHA2DS2-VASc score (standardized mean difference [ SMD ] -0.47, 95% confidence interval [ 95% CI ] -0.60, -0.34), and lower prevalence of vascular comorbidities including coronary artery disease (odds ratio [ OR ] 0.50, 95%CI 0.42, 0.61), congestive heart failure (OR 0.37, 95% CI 0.31, 0.44), peripheral artery disease (OR 0.44, 95%CI 0.29, 0.68), and previous stroke (RD 0.38, 95% CI 0.25, 0.58). Patients with AFDAS had a higher left ventricular ejection fraction (SMD 0.25, 95% CI 0.20, 0.30) and smaller mean atrial diameter (SMD -0.65, 95% CI -0.99, -0.31) than those with KAF. There were no differences in age, sex, stroke severity, or death rates between AFDAS and KAF. There were not enough studies to report differences in insular cortex involvement between AF types. Conclusions: We found significant differences in the prevalence of vascular comorbidities, structural heart disease, and stroke recurrence rates between AFDAS and KAF, suggesting that they constitute different clinical entities within the AF spectrum.
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