Atrial fibrillation is not uncommon among patients with ischemic stroke and transient ischemic stroke in China

Yilong Wang,Shuya Li,Yongjun Wang,Xiaomeng Yang,Yong Jiang,Zixiao Li,Xingquan Zhao,Liping Liu

doi:10.1186/s12883-017-0987-y

Abstract

BackgroundAtrial fibrillation (AF) is reported to be a less frequent cause of ischemic stroke in China than in Europe and North America, but it is not clear whether this is due to underestimation. Our aim was to define the true frequency of AF-associated stroke, to determine the yield of 6-day Holter ECG to detect AF in Chinese stroke patients, and to elucidate predictors of newly detected AF.MethodsPatients with acute ischemic stroke or transient ischemic attack (TIA) were enrolled in a prospective, multicenter cohort study of 6-day Holter monitoring within 7 days after stroke onset at 20 sites in China between 2013 and 2015. Independent predictors of newly-detected AF were determined by multivariate analysis.ResultsAmong 1511 patients with ischemic stroke and TIA (mean age 63 years, 33.1% women), 305 (20.2%) had either previously known (196, 13.0%) or AF newly-detected by electrocardiography (53, 3.5%) or by 6-day Holter monitoring (56/1262, 4.4%). A history of heart failure (OR = 4.70, 95%CI, 1.64–13.5), advanced age (OR = 1.06, 95%CI, 1.04–1.09), NIHSS at admission (OR = 1.06, 95%CI, 1.02–1.10), blood high density lipoprotein (HDL) (OR = 1.52, 95%CI, 1.09–2.13), together with blood triglycerides (OR = 0.64, 95%CI, 0.45–0.91) were independently associated with newly-detected AF.ConclusionsContrary to previous reports, AF-associated stroke is frequent (20%) in China if systemically sought. Prolonged noninvasive cardiac rhythm monitoring importantly increases AF detection in patients with recent ischemic stroke and TIA in China. Advanced age, history of heart failure, and higher admission NIHSS and higher level of HDL were independent indicators of newly-detected AF.Trial registrationNCT02156765 (June 5, 2014).

Highlights

Atrial fibrillation (AF) is reported to be a less frequent cause of ischemic stroke in China than in Europe and North America, but it is not clear whether this is due to underestimation
The fraction of strokes associated with atrial fibrillation has been reported to be lower in China than in European and North American stroke populations [1,2,3], but it is not clear whether this is due to its underdetection and leading to suboptimal secondary prevention
Interruptions for clinical procedures, and early detachment of the monitoring leads by patients, 1511 patients (1441 with ischemic stroke and 70with transient ischemic attack (TIA)) were included (Fig. 1)

Summary

Introduction

Atrial fibrillation (AF) is reported to be a less frequent cause of ischemic stroke in China than in Europe and North America, but it is not clear whether this is due to underestimation. Our aim was to define the true frequency of AF-associated stroke, to determine the yield of 6-day Holter ECG to detect AF in Chinese stroke patients, and to elucidate predictors of newly detected AF. The fraction of strokes associated with atrial fibrillation has been reported to be lower in China than in European and North American stroke populations [1,2,3], but it is not clear whether this is due to its underdetection and leading to suboptimal secondary prevention.

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