Stroke patients with atrial fibrillation have a worse prognosis than patients without: data from the Austrian Stroke registry

Abstract

Aims: Stroke patients with atrial fibrillation (AF) have a poorer neurological outcome than stroke patients without AF. Whether stroke patients with AF also have a higher rate of medical complications is unknown. The aim of the study was to compare the in-hospital course of acute stroke patients with and without AF.

Methods and results: The Austrian Stroke registry was a prospective multi-centre study involving 57 medical departments documenting the hospital course of consecutive stroke patients from June 1999 to October 2000. AF was diagnosed in 304 (31%) of 992 patients. Patients with AF were older (79 versus 75 years, p < 0.0004) than no-AF patients. There were more cases of pneumonia (23% versus 9%, p < 0.0004), pulmonary oedema (12% versus 6%, p < 0.0004) and symptomatic intracerebral haemorrhage (8% versus 2%, p < 0.0004) in AF compared to no-AF. In-hospital mortality was higher in AF (25% versus 14%, p < 0.0004), and neurological outcome was poorer (65 versus 90 Barthel index, p < 0.0004). On multivariable logistic regression analysis, however, AF was no predictor for mortality, but a Barthel index of zero (odds ratio 5.30, 95% CI 3.10-9.08, p < 0.0001), a National Institutes of Health Stroke Scale > 21 or comatose (odds ratio 3.13, 95% CI 2.26-4.32, p < 0.0001), age > 75 years (odds ratio 3.15, 95% CI 1.85-5.37, p < 0.0001), heart rate > 100 min(-1) (odds ratio 2.15, 95% CI 1.26-3.66, p = 0.0049), obstructive pulmonary disease (odds ratio 2.58, 95% CI 1.03-6.48, p = 0.0442) and creatinine > 125 micromol/l (odds ratio 1.84, 95% CI 1.00-3.37, p = 0.0479).

Conclusion: Stroke in AF is associated with a poor prognosis, an increased rate of medical and neurological complications and a higher in-hospital mortality than in no-AF.