Cardiovascular outcomes in patients with newly diagnosed atrial fibrillation and previous stroke: a plausible impact of stroke-heart syndrome using longitudinal data from the GLORIA-AF registry

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Abstract Background Patients with new onset atrial fibrillation (AF) and previous stroke events (PS) represent a high-risk cohort and may represent a particular manifestation of the so-called stroke-heart syndrome. Whether the long-term risks of cardiovascular (CV) outcomes and mortality are different among AF patients with different number of PS remain uncertain. Purpose To evaluate if the risks of cardiovascular outcomes are different among AF patients with different number of PS. Methods Data from phase III of the prospective GLORIA-AF (Global Registry on Long-Term Oral Anti-thrombotic Treatment in Patients With Atrial Fibrillation) were used. The risks of Major Adverse Cardiovascular Events (MACE), CV death, and all-cause mortality were analysed with COX proportional hazard regression. Results A total of 17482 AF patients [median age: 71.0 (IQR: 64.0 – 78.0) years; 45.3% female] were included in the analysis. At baseline, 1840 (10.5%) AF patients had previous strokes. Among them, 1694 (9.7%) and 170 (0.97%) patients had one (1 PS) and ≥2 previous strokes (≥2 PS) respectively. There were 1111 MACE, 562 CV deaths, and 1266 all-cause mortality after a median follow-up of 3.0 (IQR: 2.9 – 3.1) years. Multivariate Cox regression showed that patients with 1 PS and ≥2 PS had higher risks of MACE (HR: 1.50, 95% CI : [1.26 – 1.78] for 1 PS; HR: 2.65, 95% CI: [1.83 – 3.85] for ≥2 PS), and all-cause mortality (HR: 1.36, 95% CI: [1.13 – 1.58] for 1 PS; HR: 2.16, 95% CI: [1.48 – 3.16] for ≥2 PS) compared to patients without PS (table 1), with the risk of CV death (HR: 2.88, 95% CI: [1.71 – 4.84]) only higher in patients with ≥2 PS. In the subgroup analysis where only patients with PS were included, patients with ≥2 PS had higher risks of MACE, CV death, and all-cause mortality compared to patients with 1 PS. Conclusion AF patients with 1 PS or ≥2 PS events had significantly higher risks of MACE and all-cause mortality compared to AF patients without PS. Moreover, AF patients with ≥2 PS had significantly higher risks of MACE, CV death and all-cause mortality compared to AF patients with only 1 PS.