Atrial fibrillation (AF) is known to be a risk factor for ischemic stroke, and brain damage can lead to arrhythmias. Determining whether a patient's AF is triggered by stroke or pre-existing and is the underlying cause of stroke is important but challenging. In recent years, atrial fibrillation (AFDAS) detected after stroke has attracted widespread attention.
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Atrial fibrillation detected after stroke (AFDAS) was proposed as a new concept to characterize atrial fibrillation that was previously unknown but newly detected after stroke. Previous studies have shown that AFDAS is distinct from known atrial fibrillation (KAF, atrial fibrillation diagnosed prior to a stroke event) and has unique clinical and prognostic features. However, conclusions regarding the role of AFDAS in ischemic stroke studies remain inconsistent, and the role of AFDAS in haemorrhagic stroke remains unclear. Based on this, one study assessed the prevalence, risk factors, and prognostic value of AFDAS in haemorrhagic stroke compared with ischemic stroke.
Overview of the study
This is a multicenter cohort study. Patients with ischemic and hemorrhagic stroke who were hospitalized in the Chinese Stroke Center Alliance Hospital were included and classified as AFDAS, KAF, or sinus rhythm (SR) according to heart rhythm. Univariate and multivariate logistic regression analyses were used to assess the prevalence, characteristics, risk factors, and outcomes of AFDAS, KAF, and SR in different stroke subtypes.
Key results:
Prevalence of AFDAS and KAF in different stroke subtypes
A total of 913 163 stroke patients were enrolled, including 818 799 cases of ischemic stroke, 83 450 cases of intracerebral hemorrhage (ICH), and 10 914 cases of subarachnoid hemorrhage (SAH). The prevalence of AFDAS, KAF, and SR varies by stroke subtype (Figure 1). AFDAS was most common in ischemic stroke: its prevalence was higher than in patients with ICH (2.29 versus 0.80 percent, p<0.0001) and SAH patients (2.29 versus 0.70 percent, p<0.0001).
Figure 1. Prevalence of atrial fibrillation (AFDAS), known pre-stroke atrial fibrillation (KAF), and sinus rhythm (SR) detected after stroke subtypes of stroke
In-hospital morbidity and mortality
The fully adjusted model showed that, similar to KAF, AFDAS was associated with an increased risk of in-hospital mortality compared with SR in ischemic stroke (OR 2.23, 95% CI 1.94-2.56) and ICH (OR 2.84, 95% CI 1.84-4.38) (Table 1, Table 2).
表1. 根据KAF/AFDAS/SR,缺血性卒中患者死亡率的OR(95% CI)
表2. 根据KAF/AFDAS/SR,ICH患者死亡率的OR(95% CI)
Independent risk factors for AFDAS
卒中亚型之间的危险因素存在差异；高龄是缺血性卒中（OR 1.06，95% CI 1.06-1.06）、脑出血（OR 1.08，95% CI 1.07-1.09）和蛛网膜下腔出血（OR 1.07，95% CI 1.05-1.10）AFDAS共有的常见独立危险因素（均为P＜0.0001）。
Summary of the discussion
The prevalence, characteristics, and risk factors of AFDAS and KAF vary among different stroke subtypes. In ischemic stroke and intracerebral hemorrhage, AFDAS is associated with an increased risk of mortality compared with sinus rhythm. Cardiac rhythm monitoring and risk factor modification after ischemic and hemorrhagic stroke are essential in clinical practice. More targeted studies are needed to better address the pathophysiology of AFDAS and to identify specific biomarkers to distinguish between neurogenic AFDAS and cardiogenic AFDAS. In addition, randomized clinical trials are needed to determine the best treatment strategy for people with stroke with AFDAS.
医脉通编译自：Guo J, Li Z, Gu H, et al. Prevalence, risk factors and prognostic value of atrial fibrillation detected after stroke after haemorrhagic versus ischaemic stroke. Stroke Vasc Neurol. 2024 Feb 16:svn-2023-002974.
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