Outcome of cardio-embolic stroke by atrial fibrillation: Lesson from Subsaharan Africa setting

Abstract

Atrial fibrillation (AF) is the leading cause of cardio-embolic stroke (CES) but data in Subsaharan African were scarce. The aim of this study was to describe the clinical pattern and to evaluate the outcome of CES due to AF. A 8-year retrospective cohort study was carried out in the Neurological Unit and the Intensive Care Unit of the Douala General Hospital. Were included all the files of patient admitted with established diagnosis of CES due to AF confirmed respectively by CT scan and ECG. Standard scores (CHA2DS2-VASc > 2, HAS-BLED≥3 and modified Rankin Score>2) were used respectively to evaluate embolic risk, risk of bleeding and poor functional outcome. Survival was determined using Kaplan Meier curve. 85 files CES due to AF were included (52% women) with a mean age of 69±11,96 years. 34.9% of patients have pre-existing AF. Embolic and hemorrhagic risks were classified high in 91.3% and 94.1% respectively. Antithrombotic treatment was introduced in 95.5% during hospitalisation. In-hospital mortality rate was 24.7% and the survival rate at 2 years was 19.1%. Stroke recurrency was found in 7 (11%) in a mean delay of 3.4 months post-stroke and was associated with preexisting AF, the absence of antithrombotic medication for AF (P < 0.001). Functional outcome was poor in 55.2% at hospital release. CES due to AF affects mostly old-patients in Subsaharan Africa and are associated with high mortality and recurrency rates. Short term functional outcome is poor on 1 patient over 2.