(Stroke. 1997;28:311-315.)
© 1997 American Heart Association, Inc.
Articles |
Atrial Fibrillation and Stroke
Mortality and Causes of Death After the First Acute Ischemic Stroke
the Department of Neurology, University of Turku (M.M.K., R.J.M.); the Heart and Stroke Center, Turku (P.I.-R.); the National Public Health Institute, Helsinki (V.S., C.S., J. Torppa, J. Tuomilehto); the Central Hospital of North Karelia (K.S.); the University Hospital of Kuopio (J.S.); and the Loimaa District Hospital (E.K.), Finland.
Correspondence to Dr Minna M. Kaarisalo, Rykmentintie 26, 20810 Turku, Finland.
Background and Purpose Atrial fibrillation (AF) is a risk factor for stroke. This study was undertaken to determine the influence of AF on the mortality of stroke patients and on the causes of death after a stroke event.
Methods Patients with first ischemic stroke who were 35 to 74 years old and registered in the FINMONICA stroke register during 1982 through 1992 were analyzed (n=6912). There were 642 patients with AF (9.3%) (mean age, 67 years) and 6270 patients without AF (90.3%) (mean age, 63 years). The association between AF and stroke mortality was investigated by use of logistic regression and Cox proportional hazards models.
Results Mortality was higher in the AF group both at 28 days (19.5% versus 14.4%, P<.001) and 1 year after the attack (30.5% versus 21.8%, P<.001). After adjustment for age and sex, the odds ratio for 28-day case fatality (AF versus non-AF) was 1.27 (95% CI, 1.03 to 1.56; P=.003), and that for 1-year mortality was 1.36 (95% CI, 1.14 to 1.63; P<.001). In the proportional hazards model, AF was a significant independent risk factor for 1-year mortality (hazard ratio, 1.26; 95% CI, 1.09 to 1.46; P=.002). Cardiac causes of death were more common in the AF group at the acute stage. In the course of 1 year, there were no differences in the distributions of causes of death.
Conclusions Stroke patients with AF are at high risk of death both at the acute phase of stroke and during the subsequent year after the first acute stroke event. Mortality from cardiac diseases prevailed in the AF group during the acute phase of stroke. Careful cardiac evaluation and treatment are essential in patients with AF and stroke.
Key Words: atrial fibrillation • cerebral ischemia • prognosis • mortality
This article has been cited by other articles:
 |
|
 |
|
  P. Kirchhof, J. Bax, C. Blomstrom-Lundquist, H. Calkins, A. J. Camm, R. Cappato, F. Cosio, H. Crijns, H.-C. Diener, A. Goette, et al. Early and comprehensive management of atrial fibrillation: Proceedings from the 2nd AFNET/EHRA consensus conference on atrial fibrillation entitled 'research perspectives in atrial fibrillation' Europace, July 1, 2009; 11(7): 860 - 885. [Full Text] [PDF]
|
|
|
|
 |
|
 P. Kirchhof, J. Bax, C. Blomstrom-Lundquist, H. Calkins, A. John Camm, R. Cappato, F. Cosio, H. Crijns, H.-C. Diener, A. Goette, et al. Early and comprehensive management of atrial fibrillation: executive summary of the proceedings from the 2nd AFNET-EHRA consensus conference 'research perspectives in AF' Eur. Heart J., June 17, 2009; (2009) ehp235v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Appelros, B. Stegmayr, and A. Terent Sex Differences in Stroke Epidemiology: A Systematic Review Stroke, April 1, 2009; 40(4): 1082 - 1090. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Bejot, D. B. Salem, G. V. Osseby, G. Couvreur, J. Durier, C. Marie, Y. Cottin, T. Moreau, and M. Giroud Epidemiology of ischemic stroke from atrial fibrillation in Dijon, France, from 1985 to 2006 Neurology, January 27, 2009; 72(4): 346 - 353. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I van Wijk, P J Koudstaal, L J Kappelle, J van Gijn, J W Gorter, A Algra, and for the LiLAC Study Group Long-term occurrence of death and cardiovascular events in patients with transient ischaemic attack or minor ischaemic stroke: comparison between arterial and cardiac source of the index event J. Neurol. Neurosurg. Psychiatry, August 1, 2008; 79(8): 895 - 899. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Miyasaka, M. E. Barnes, B. J. Gersh, S. S. Cha, J. B. Seward, K. R. Bailey, T. Iwasaka, and T. S.M. Tsang Time Trends of Ischemic Stroke Incidence and Mortality in Patients Diagnosed With First Atrial Fibrillation in 1980 to 2000: Report of a Community-Based Study Stroke, November 1, 2005; 36(11): 2362 - 2366. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Marini, F. De Santis, S. Sacco, T. Russo, L. Olivieri, R. Totaro, and A. Carolei Contribution of Atrial Fibrillation to Incidence and Outcome of Ischemic Stroke: Results From a Population-Based Study Stroke, June 1, 2005; 36(6): 1115 - 1119. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K Kimura, K Minematsu, T Yamaguchi, and for the Japan Multicenter Stroke Investigators' Co Atrial fibrillation as a predictive factor for severe stroke and early death in 15 831 patients with acute ischaemic stroke J. Neurol. Neurosurg. Psychiatry, May 1, 2005; 76(5): 679 - 683. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Tanaka, Y. Nakayama, Y. Maeda, T. Nishioka, M. Shirakawa, and K. Tsumura Electrocardiographic Q-waves as a predictor of mortality in patients with cerebral infarction Neurology, May 25, 2004; 62(10): 1818 - 1821. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. M. Hylek, A. S. Go, Y. Chang, N. G. Jensvold, L. E. Henault, J. V. Selby, and D. E. Singer Effect of Intensity of Oral Anticoagulation on Stroke Severity and Mortality in Atrial Fibrillation N. Engl. J. Med., September 11, 2003; 349(11): 1019 - 1026. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W.T. Longstreth Jr., C. Bernick, A. Fitzpatrick, M. Cushman, L. Knepper, J. Lima, and C.D. Furberg Frequency and predictors of stroke death in 5,888 participants in the Cardiovascular Health Study Neurology, February 13, 2001; 56(3): 368 - 375. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Lamassa, A. Di Carlo, G. Pracucci, A. M. Basile, G. Trefoloni, P. Vanni, S. Spolveri, M. C. Baruffi, G. Landini, A. Ghetti, et al. Characteristics, Outcome, and Care of Stroke Associated With Atrial Fibrillation in Europe : Data From a Multicenter Multinational Hospital-Based Registry (The European Community Stroke Project) Stroke, February 1, 2001; 32(2): 392 - 398. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. C. Sharma, S. Fletcher, M. Vassallo, and I. Ross Cardiovascular disease and outcome of acute stroke: influence of pre-existing cardiac failure Eur J Heart Fail, June 1, 2000; 2(2): 145 - 150. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. N. Kernan, C. M. Viscoli, L. M. Brass, R. W. Makuch, P. M. Sarrel, R. S. Roberts, M. Gent, P. Rothwell, R. L. Sacco, R.-C. Liu, et al. The Stroke Prognosis Instrument II (SPI-II) : A Clinical Prediction Instrument for Patients With Transient Ischemia and Nondisabling Ischemic Stroke Stroke, February 1, 2000; 31(2): 456 - 462. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Carter, A. J. Catto, and P. J. Grant Association of the {alpha}-Fibrinogen Thr312Ala Polymorphism With Poststroke Mortality in Subjects With Atrial Fibrillation Circulation, May 11, 1999; 99(18): 2423 - 2426. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P.-K. Yip, J.-S. Jeng, T.-K. Lee, Y.-C. Chang, Z.-S. Huang, S.-K. Ng, and R.-C. Chen Subtypes of Ischemic Stroke : A Hospital-Based Stroke Registry in Taiwan (SCAN-IV) Stroke, December 1, 1997; 28(12): 2507 - 2512. [Abstract] [Full Text]
|
|