Original Paper

Stroke Associated with Atrial Fibrillation - Incidence and Early Outcomes in the North Dublin Population Stroke Study
Niamh Hannon^a, Orla Sheehan^a, Lisa Kelly^a, Michael Marnane^a, Aine Merwick^a, Alan Moore^b, Lorraine Kyne^a, Joseph Duggan^a, Joan Moroney^b, Patricia M.E. McCormack^c, Leslie Daly^d, Nicola Fitz-Simon^d, Dawn Harris^a, Gillian Horgan^a, Emma B. Williams^a, Karen L. Furie^e, Peter J. Kelly<sup>a

a</sup>Neurovascular Clinical Science Unit, Mater University Hospital,
^bBeaumont Hospital,
^cConnolly Hospital and
^dSchool of Public Health and Population Science, University College Dublin, Dublin, Ireland;
^eStroke Service, Department of Neurology, Massachusetts General Hospital, Boston, Mass., USA

Address of Corresponding Author

Cerebrovasc Dis 2010;29:43-49 (DOI: 10.1159/000255973)

  Key Words

• Atrial fibrillation
• Stroke prevention
• Anticoagulation

  Abstract

Background: Prospective population-based studies are important to accurately determine the incidence and characteristics of stroke associated with atrial fibrillation (AF), while avoiding selection bias which may complicate hospital-based studies. Methods: We investigated AF-associated stroke within the North Dublin Population Stroke Study, a prospective cohort study of stroke/transient ischaemic attack in 294,592 individuals, according to recommended criteria for rigorous stroke epidemiological studies. Results: Of 568 stroke patients ascertained in the first year, 31.2% (177/568) were associated with AF (90.4%, i.e. 160/177 ischaemic infarcts). The crude incidence rate of all AF-associated stroke was 60/100,000 person-years (95% CI = 52-70). Prior stroke was almost twice as common in AF compared to non-AF groups (21.9 vs. 12.8%, p = 0.01). The frequency of AF progressively increased across ischaemic stroke patients stratified by increasing stroke severity (NIHSS 0-4, 29.7%; 5-9, 38.1%; 10-14, 43.8%; 15, 53.3%, p < 0.0001). The 90-day trajectory of recovery of AF-associated stroke was identical to that of non-AF stroke, but Rankin scores in AF stroke remained higher at 7, 28 and 90 days (p < 0.001 for all). Discussion: AF-associated stroke occurred in one third of all patients and was associated with a distinct profile of recurrent, severe and disabling stroke. Targeted strategies to increase anticoagulation rates may provide a substantial benefit to prevent severe disabling stroke at a population level.

Copyright © 2009 S. Karger AG, Basel

  Author Contacts

Prof. Peter Kelly
Neurovascular Clinical Science Unit, Catherine McAuley Research Centre
Nelson Street, Mater University Hospital
Dublin 7 (Ireland)
Tel. +353 1 716 6374, Fax +353 1 716 6357, E-Mail ndpss@mater.ie

  Article Information

Received: April 6, 2009
Accepted: August 12, 2009
Published online: November 5, 2009
Number of Print Pages : 7
Number of Figures : 3, Number of Tables : 2, Number of References : 28