Abstract
Abstract Introduction Acute ischemic cerebrovascular stroke (CVS) can be the first clinical manifestation of atrial fibrillation (AF), that is why large-scale screening programs for AF are currently implemented especially in individuals more than or equal 65 years old. Yet, to date, cost-effectiveness data have relied on assumptions of stroke rates observed in patients with established AF, while the true incidence rates of undiagnosed AF presenting as a stroke remain unknown. Purpose To estimate the incidence of patients with no history of AF who are presented with acute ischemic CVS and are found to be in AF at the time of presentation or developed atrial fibrillation during the hospital stay. Methods A retrospective analysis of all patients admitted with acute CVS to a tertiary care stroke specialized center in the period from 01/01/2014 till 31/12/2017. Ischemic CVS is confirmed by either multislice computed tomography (MSCT) or magnetic resonance imaging (MRI) of the brain. AF is documented by electrocardiography (ECG) that is made at admission or during hospital stay. Patients with history of AF on rate or rhythm-control therapy were excluded from the study. Results Of the 3299 patients admitted by acute ischemic CVS, 707 (21.43%) patients had history of AF and they were on medical rate or rhythm control therapy and thus were excluded from the study. Of the remaining 2592 patients eligible for the study, 1666 (64.27%) were males with a mean age of 56.06 years (±16.01). Regarding ECG, 2313 (89.24%) patients were in sinus rhythm and other non-AF rhythms and 211 (8.14%) presented with AF rhythm and 68 (2.62%) developed AF during their hospital stay with a cumulative incidence of (10.76%). Table 1. Baseline patient characteristics and ECG data (n=2592) Risk factors n=2592 Hypertension 1849 (71.33%) Diabetes Mellitus 925 (35.69%) Smoking 1445 (55.75%) ECG data Non-AF 2313 (89.24%) AF on admission 211 (8.14%) AF in hospital 68 (2.62%) Total AF 279 (10.76%) Undiagnosed AF in acute ischemic CVS Conclusion The incidence of undiagnosed atrial fibrillation in patients presented with acute cerebrovascular stroke is significantly high. Implementation of good screening programs can significantly reduce the risk of disabilities and morbidities.
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