Global Survey of the Frequency of Atrial Fibrillation-Associated Stroke: Embolic Stroke of Undetermined Source Global Registry

Kanjana S Perera¹, Thomas Vanassche², Jackie Bosch², Balakumar Swaminathan², Hardi Mundl², Mohana Giruparajah², Miguel A Barboza², Martin J O'Donnell², Maia Gomez-Schneider², Graeme J Hankey², Byung-Woo Yoon², Artemio Roxas Jr², Philippa Lavallee², Joao Sargento-Freitas², Nikolay Shamalov², Raf Brouns², Rubens J Gagliardi², Scott E Kasner², Alessio Pieroni², Philipp Vermehren², Kazuo Kitagawa², Yongjun Wang², Keith Muir², Jonathan M Coutinho², Stuart J Connolly², Robert G Hart²; ESUS Global Registry Investigators

Collaborators, Affiliations

Collaborators

ESUS Global Registry Investigators:
K Czeto, M Kahn, K R Mattina, S F Ameriso, V Pujol-Lereis, M Hawkes, L Pertierra, N Perera, A De Smedt, R Van Dyck, R J Van Hooff, L Yperzeele, V D B Gagliardi, L G Cerqueir, X Yang, W Chen, P Amarenco, C Guidoux, P A Ringleb, D Bereczki, I Vastagh, M Canavan, D Toni, A Anzini, C Colosimo, M De Michele, M T Di Mascio, L Durastanti, A Falcou, S Fausti, A Mancini, S Mizumo, S Uchiyama, C K Kim, S Jung, Y Kim, J A Kim, J Y Jo, A Arauz, A Quiroz-Compean, J Colin, P J Nederkoorn, V P Marianito, L Cunha, G Santo, F Silva, J Coelho, M Kustova, K Meshkova, G Williams, J Siegler, C Zhang, N Gallatti, M Kruszewski

Affiliations

¹ From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la Infancia (FLENI), Buenos Aires, Argentina (M.G.-S.); School of Medicine and Pharmacology, University of Western Australia, Sir Charles Gairdner Hospital, Perth, Australia (G.J.H.); Department of Neurology, Seoul National University Hospital, Korea (B.-W.Y.); Medical City Hospital, Manila, Philippines (A.R.); Department of Neurology, Bichat Hospital, Paris, France (P.L.); Centro Hospitalar e Universitário de Coimbra, Portugal (J.S.-F.); Pirogov Russian National Research Medical University, Moscow, Russia (N.S.); Universitair Ziekenhuis Brussel, Belgium (R.B.); Santa Casa de São Paulo, Medical School, Brazil (R.J.G.); Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia (S.E.K.); Emergency Department Stroke Unit, Hospital Policlinico Umberto I, Department of Neurology and Psychiatry, 'Sapienza' University, Rome, Italy (A.P.); Department of Neurology, University Hospital Heidelberg, Germany (P.V.); Department of Neurology, Tokyo Women's Medical University, Japan (K.K.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Y.W.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.M.); and Academic Medical Center, Amsterdam, the Netherlands (J.M.C.). kanjana.perera@phri.ca.
² From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la Infancia (FLENI), Buenos Aires, Argentina (M.G.-S.); School of Medicine and Pharmacology, University of Western Australia, Sir Charles Gairdner Hospital, Perth, Australia (G.J.H.); Department of Neurology, Seoul National University Hospital, Korea (B.-W.Y.); Medical City Hospital, Manila, Philippines (A.R.); Department of Neurology, Bichat Hospital, Paris, France (P.L.); Centro Hospitalar e Universitário de Coimbra, Portugal (J.S.-F.); Pirogov Russian National Research Medical University, Moscow, Russia (N.S.); Universitair Ziekenhuis Brussel, Belgium (R.B.); Santa Casa de São Paulo, Medical School, Brazil (R.J.G.); Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia (S.E.K.); Emergency Department Stroke Unit, Hospital Policlinico Umberto I, Department of Neurology and Psychiatry, 'Sapienza' University, Rome, Italy (A.P.); Department of Neurology, University Hospital Heidelberg, Germany (P.V.); Department of Neurology, Tokyo Women's Medical University, Japan (K.K.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Y.W.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.M.); and Academic Medical Center, Amsterdam, the Netherlands (J.M.C.).

PMID: 27507860
DOI: 10.1161/STROKEAHA.116.013378

Free article

Global Survey of the Frequency of Atrial Fibrillation-Associated Stroke: Embolic Stroke of Undetermined Source Global Registry

Kanjana S Perera et al. Stroke. 2016 Sep.

Free article

. 2016 Sep;47(9):2197-202.

doi: 10.1161/STROKEAHA.116.013378. Epub 2016 Aug 9.

Authors

Collaborators

ESUS Global Registry Investigators:
K Czeto, M Kahn, K R Mattina, S F Ameriso, V Pujol-Lereis, M Hawkes, L Pertierra, N Perera, A De Smedt, R Van Dyck, R J Van Hooff, L Yperzeele, V D B Gagliardi, L G Cerqueir, X Yang, W Chen, P Amarenco, C Guidoux, P A Ringleb, D Bereczki, I Vastagh, M Canavan, D Toni, A Anzini, C Colosimo, M De Michele, M T Di Mascio, L Durastanti, A Falcou, S Fausti, A Mancini, S Mizumo, S Uchiyama, C K Kim, S Jung, Y Kim, J A Kim, J Y Jo, A Arauz, A Quiroz-Compean, J Colin, P J Nederkoorn, V P Marianito, L Cunha, G Santo, F Silva, J Coelho, M Kustova, K Meshkova, G Williams, J Siegler, C Zhang, N Gallatti, M Kruszewski

Affiliations

¹ From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la Infancia (FLENI), Buenos Aires, Argentina (M.G.-S.); School of Medicine and Pharmacology, University of Western Australia, Sir Charles Gairdner Hospital, Perth, Australia (G.J.H.); Department of Neurology, Seoul National University Hospital, Korea (B.-W.Y.); Medical City Hospital, Manila, Philippines (A.R.); Department of Neurology, Bichat Hospital, Paris, France (P.L.); Centro Hospitalar e Universitário de Coimbra, Portugal (J.S.-F.); Pirogov Russian National Research Medical University, Moscow, Russia (N.S.); Universitair Ziekenhuis Brussel, Belgium (R.B.); Santa Casa de São Paulo, Medical School, Brazil (R.J.G.); Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia (S.E.K.); Emergency Department Stroke Unit, Hospital Policlinico Umberto I, Department of Neurology and Psychiatry, 'Sapienza' University, Rome, Italy (A.P.); Department of Neurology, University Hospital Heidelberg, Germany (P.V.); Department of Neurology, Tokyo Women's Medical University, Japan (K.K.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Y.W.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.M.); and Academic Medical Center, Amsterdam, the Netherlands (J.M.C.). kanjana.perera@phri.ca.
² From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la Infancia (FLENI), Buenos Aires, Argentina (M.G.-S.); School of Medicine and Pharmacology, University of Western Australia, Sir Charles Gairdner Hospital, Perth, Australia (G.J.H.); Department of Neurology, Seoul National University Hospital, Korea (B.-W.Y.); Medical City Hospital, Manila, Philippines (A.R.); Department of Neurology, Bichat Hospital, Paris, France (P.L.); Centro Hospitalar e Universitário de Coimbra, Portugal (J.S.-F.); Pirogov Russian National Research Medical University, Moscow, Russia (N.S.); Universitair Ziekenhuis Brussel, Belgium (R.B.); Santa Casa de São Paulo, Medical School, Brazil (R.J.G.); Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia (S.E.K.); Emergency Department Stroke Unit, Hospital Policlinico Umberto I, Department of Neurology and Psychiatry, 'Sapienza' University, Rome, Italy (A.P.); Department of Neurology, University Hospital Heidelberg, Germany (P.V.); Department of Neurology, Tokyo Women's Medical University, Japan (K.K.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Y.W.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.M.); and Academic Medical Center, Amsterdam, the Netherlands (J.M.C.).

PMID: 27507860
DOI: 10.1161/STROKEAHA.116.013378

Abstract

Background and purpose: Atrial fibrillation (AF) is increasingly recognized as the single most important cause of disabling ischemic stroke in the elderly. We undertook an international survey to characterize the frequency of AF-associated stroke, methods of AF detection, and patient features.

Methods: Consecutive patients hospitalized for ischemic stroke in 2013 to 2014 were surveyed from 19 stroke research centers in 19 different countries. Data were analyzed by global regions and World Bank income levels.

Results: Of 2144 patients with ischemic stroke, 590 (28%; 95% confidence interval, 25.6-29.5) had AF-associated stroke, with highest frequencies in North America (35%) and Europe (33%) and lowest in Latin America (17%). Most had a history of AF before stroke (15%) or newly detected AF on electrocardiography (10%); only 2% of patients with ischemic stroke had unsuspected AF detected by poststroke cardiac rhythm monitoring. The mean age and 30-day mortality rate of patients with AF-associated stroke (75 years; SD, 11.5 years; 10%; 95% confidence interval, 7.6-12.6, respectively) were substantially higher than those of patients without AF (64 years; SD, 15.58 years; 4%; 95% confidence interval, 3.3-5.4; P<0.001 for both comparisons). There was a strong positive correlation between the mean age and the frequency of AF (r=0.76; P=0.0002).

Conclusions: This cross-sectional global sample of patients with recent ischemic stroke shows a substantial frequency of AF-associated stroke throughout the world in proportion to the mean age of the stroke population. Most AF is identified by history or electrocardiography; the yield of conventional short-duration cardiac rhythm monitoring is relatively low. Patients with AF-associated stroke were typically elderly (>75 years old) and more often women.

Keywords: atrial fibrillation; cardiac rhythm monitoring; electrocardiography; embolism; stroke.

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Global Survey of the Frequency of Atrial Fibrillation-Associated Stroke: Embolic Stroke of Undetermined Source Global Registry

Collaborators

Affiliations

Global Survey of the Frequency of Atrial Fibrillation-Associated Stroke: Embolic Stroke of Undetermined Source Global Registry

Authors

Collaborators

Affiliations

Abstract

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources