Stroke Patients with Atrial Fibrillation have frequent Early Cardiac Complications and Require Monitoring

  • Dr Hans Tu, Royal Melbourne Hospital, University of Melbourne, Australia
  • Dr Bruce Campbell, Royal Melbourme Hospital, University of Melbourne, Australia
  • Dr Leonid Churilov, Florey Neuroscience Institutes, University of Melbourne, Australia
  • Prof Jonathan Kalman, Royal Melbourne Hospital, University of Melbourne, Australia
  • Prof Kennedy Lees, University of Glasgow, United Kingdom
  • Prof Patrick Lyden, Cedars-Sinai Medical Center, United States
  • Prof Geoffrey Donnan, Florey Neuroscience Institutes, University of Melbourne, Australia
  • Prof Stephen Davis, Royal Melbourne Hospital, University of Melbourne, Australia

Background: Atrial Fibrillation (AF) is associated with worse outcomes following stroke and more frequent cardiac complications in the general population. We aimed to establish whether early cardiac complications contribute to the poorer stroke outcomes in AF patients, independent of baseline stroke severity and cardiovascular risk factors.
Methods: We searched VISTA-Acute, an academic database containing standardized data for 28,131 patients from randomized-controlled acute stroke trials and registries, for placebo-treated patients with complete documentation of baseline demographics, cardiovascular risk factors, presence/absence of AF, neurologic impairment (NIHSS), cardiac complications and 3-month outcome (mRS). Multivariate modeling was used to test the association between AF, stroke outcome and serious cardiac adverse events (SCAEs), a composite endpoint including acute coronary syndrome, symptomatic heart failure, cardiopulmonary arrest, VT, VF and cardiac mortality.
Results: In VISTA-Acute, 2865 patients met the selection criteria, of whom 819 had AF. At baseline, patients with AF were older (mean 75 vs 67 years, p<0.001) and had greater neurologic impairment (median NIHSS 15 vs 13, p<0.001). The median time to first CAE was 3 days for both patients with and without AF. SCAEs occurred more frequently in patients with AF (14.2 vs 6%, OR 2.58, 95%CI1.97-3.37). At 3 months, AF was independently associated with SCAEs (OR2.16, 95%CI1.62-2.89) and early mortality (OR1.44, 95%CI1.14-1.81) after adjusting for all baseline imbalances.
Conclusion: Early cardiac complications are common after stroke and are independently associated with AF. These results highlight the need for more intense cardiac monitoring and evaluation in acute ischemic stroke patients with AF.