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Observational Study
. 2019 Jul 24;9(7):e028387.
doi: 10.1136/bmjopen-2018-028387.

Potential missed opportunities to prevent ischaemic stroke: prospective multicentre cohort study of atrial fibrillation-associated ischaemic stroke and TIA

Duncan Wilson  1   2 , Gareth Ambler  3 , Clare Shakeshaft  2 , Gargi Banerjee  2 , Andreas Charidimou  4   5 , David Seiffge  2 , Mark White  2 , Hannah Cohen  6 , Tarek Yousry  7 , Al-Shahi Salman R  8 , Gregory Y H Lip  9 , Keith Muir  10 , Martin M Brown  11 , H R Jäger  4 , David J Werring  12 ; CROMIS-2 collaborators
Collaborators, Affiliations
Observational Study

Potential missed opportunities to prevent ischaemic stroke: prospective multicentre cohort study of atrial fibrillation-associated ischaemic stroke and TIA

Duncan Wilson et al. BMJ Open. .

Abstract

Objective: We report on: (1) the proportion of patients with known atrial fibrillation (AF); and (2) demographic, clinical or radiological differences between patients with known AF (and not treated) and patients with newly diagnosed AF, in a cohort of patients who presented with ischaemic stroke or transient ischaemic attack (TIA) not previously treated with anticoagulation.

Design: We reviewed cross-sectional baseline demographic and clinical data from a prospective observational cohort study, (CROMIS-2).

Setting: Patients were recruited from 79 hospital stroke centres throughout the UK and one centre in the Netherlands.

Participants: Patients were eligible if they were adults who presented with ischaemic stroke or TIA and AF and had not been previously treated with oral anticoagulation.

Main outcome measures: Proportion of patients with known AF before index ischaemic stroke or TIA from a cohort of patients who have not been previously treated with oral anticoagulation. Secondary analysis includes the comparison of CHA2DS2-VASc and HAS-BLED scores and other demographics and risk factors between those with newly diagnosed AF and those with previously known AF.

Results: Of 1470 patients included in the analysis (mean age 76 years (SD 10)), 622 (42%) were female; 999 (68%) patients had newly diagnosed AF and 471 (32%) patients had known AF. Of the 471 patients with known AF, 68% had a strong indication for anticoagulation and 89% should have been considered for anticoagulation based upon CHA2DS2-VASc score. Patients with known AF were more likely to have a prior history of dementia (4% vs 2%, p=0.02) and had higher HAS-BLED scores (median 3 vs 2). CHA2DS2-VASc, other risk factors and demographics were similar.

Conclusions: About 1/3 of patients who present with stroke and have AF who have not been treated with oral anticoagulation have previously known AF. Of these patients, at least 68% were not adequately treated with oral anticoagulation.

Trial registration number: NCT02513316.

Keywords: anticoagulation; atrial fibrillation; stroke.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Distribution of HAS-BLED and CHA2DS2-VASc scores between patients with known AF versus those with newly diagnosed AF. AF, atrial fibrillation.
See this image and copyright information in PMC

References

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