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Multicenter Study
. 2025 Jan 21;14(2):e038448.
doi: 10.1161/JAHA.124.038448. Epub 2025 Jan 16.

Number of Previous Strokes and the Association With Clinical Outcomes of Patients With Atrial Fibrillation: Longitudinal Data From the GLORIA-AF Registry

Steven Ho Man Lam  1 , Giulio Francesco Romiti  1   2 , Bernadette Corica  1 , Tommaso Bucci  1 , Brian Olshansky  3 , Tze-Fan Chao  4   5 , Menno V Huisman  6 , Gregory Y H Lip  1   7 ; GLORIA‐AF Investigators
Affiliations
Multicenter Study

Number of Previous Strokes and the Association With Clinical Outcomes of Patients With Atrial Fibrillation: Longitudinal Data From the GLORIA-AF Registry

Steven Ho Man Lam et al. J Am Heart Assoc. .

Abstract

Background: Patients with atrial fibrillation (AF) who suffered a previous stroke are at increased risk of recurrent thromboembolic events and other major outcomes. The impact of the number of stroke episodes on the natural history of patients with AF is still unclear.

Methods and results: Using data from the international, multicenter, and prospective GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation) Registry Phase III, we categorized patients with a recent diagnosis of non-valvular AF according to the number of previous strokes (either 0, 1, or ≥2 episodes). We analyzed use of oral anticoagulants through multiple logistic regression model, and risk of major outcomes using multiple Cox-regression models; our primary outcome was all-cause death. Among 21 223 patients (mean age: 70.2±10.3 years; 44.9% female) included, 2251 (10.6%) had a previous history of stroke, and 216 (1.0%) had ≥2 or more strokes. Oral anticoagulants were used in ≥80% of patients regardless of the numbers of previous stroke, although those with 1 (versus >1) prior stroke showed lower odds of receiving oral anticoagulants (odds ratio [95% CI]: 0.83 [0.73-0.94]). During 3-years follow-up, the risk of all-cause mortality increased with the number of previous strokes (hazard ratio [95% CI]: 1.46 [1.28-1.67] and 2.43 [1.79-3.29] for 1 versus 0 and ≥2 versus 0 previous strokes, respectively). Similar results were observed for other secondary outcomes, including thromboembolism, but not for major bleeding.

Conclusions: History of stroke still represents a key risk factor in patients with AF. Patients who suffered more than 1 episodes of stroke had significantly worse prognosis and further efforts may be required to improve their clinical outcomes.

Keywords: atrial fibrillation; cardiovascular risk; number of stroke events.

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Conflict of interest statement

G.F.R. reports consultancy for Boehringer Ingelheim and an educational grant from Anthos. No fees are directly received personally. B.O. has one disclosure AstraZeneca DSMB, Consultant for Boehringer Ingelheim. T.F.C. reported honoraria for lectures from Boehringer Ingelheim, Bayer, Pfizer, and Daiichi Sankyo, outside the submitted work. M.V.H. has been receiving research grants from the Dutch Healthcare Fund, Dutch Heart Foundation, BMS‐Pfizer, Bayer Healthcare and Boehringer Ingelheim and consulting fees from BMS‐Pfizer, Bayer Healthcare and Boehringer Ingelheim to the institution. G.Y.H.L. has been consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, Anthos and Daiichi‐Sankyo. No fees are directly received personally. All the disclosures happened outside the submitted work. He is a National Institute for Health and Care Research Senior Investigator and co‐PI of the AFFIRMO project on multimorbidity in AF (grant agreement No 899871), TARGET project on digital twins for personalized management of atrial fibrillation and stroke (grant agreement No 101136244) and ARISTOTELES project on artificial intelligence for management of chronic long term conditions (grant agreement No 101080189), which are all funded by the EU's Horizon Europe Research & Innovation program. The remaining authors have no disclosures to report.

Figures

Figure 1
Figure 1. Use of antithrombotics according to the previous number of strokes.
NOAC indicates non vitamin‐K antagonist oral anticoagulants; and VKA, Vitamin K antagonist.
Figure 2
Figure 2. Survival curves according to the number of previous strokes for the primary outcome of all‐cause death.
Log‐Rank P<0.001.
See this image and copyright information in PMC

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