Ischemic stroke with Atrial Fibrillation, characteristics and time-trends over 12-year period 2006-2017 in the Dijon Stroke Registry

Abstract

Because of the aging population, an increase in the prevalence of atrial fibrillation (AF) is currently observed, thus exposing to a rise in AF-related ischemic stroke (IS). The aim was to analyze the current prevalence of AF among IS patients (period 2014-17), their characteristics, and temporal trends from 2006 to 2017, in the population-based Dijon Stroke Registry. We used data from the Dijon Stroke Registry. IS patients were included between 2006 and 2017 ( n = 2,417). Vascular risk factors and past medical history were collected, including AF. “Previous AF” was defined if it was mentioned in the medical file before stroke, and “newly-diagnosed AF” if it was diagnosed during the diagnostic work-up of the acute stroke. We assumed Poisson distribution for the annual number of AF cases. During the period 2014-2017, over the 796 IS patients recorded in the Dijon Stroke Registry, 239 (30.0%) had AF, of whom 79 (9.9% of IS patients) had newly-diagnosed AF and 98 (12.3%) had previous AF treated with oral anticoagulants. IS patients with AF had more disabilities and a higher initial severity according to the NIHSS score compared to those without AF. AF patients had also more frequent hypercholesterolemia and heart failure. The age-adjusted prevalence of AF in IS patients increased between 2006 and 2017 (+ 9% per time period), with an important increase in men aged 65-74 (+ 81%) and women aged ≥ 85 (+ 24%) years old, and a significant decrease in women aged 65-74years old (-39%). The use of oral anticoagulant treatment in previous AF patients increased between 2006-2009 and 2014-2017 (29.3% to 61.3%, P < 0.0001). The increase in AF prevalence in IS patients could be related to a better diagnosis of this condition. Despite some improvements, an underuse of oral anticoagulation in patients with previously known AF was still observed, thus indicating a prevention target on which to act to reduce the future burden of stroke.