In-hospital course of stroke patients with vs without AF

1
In-hospital course of stroke patients with vs
without AF
With AF
Without AF
More severe stroke on admission Lower Barthel
Index Higher proportion with Rankin Scale
score () Higher rate of medical
complications Pneumonia () Pulmonary edema
() Symptomatic intracerebral hemorrhage
() Mortality () Poorer neurological status
at discharge Lower Barthel Index Higher
Rankin Scale score
1552
4031
2312825
96214
604
852
Steger C et al. Eur Heart J. 20046in press.
P lt 0.0004 for all comparisons
2
Detection of AF after acute stroke/TIA
N 149
Stroke/TIA
No. AF detected
Yes
ECG
AF?
4 (2.7)
No
n 145
Additional ECG
Yes
6 (4.1)
No
n 139
24-hr Holter
Yes
7 (4.9)
No
n 88/132
7-day ELR
Yes
5 (5.7)
AF?
Jabaudon D et al. Stroke. 2004351647-51.
ELR 2-lead event-loop recording device
3
Risk of AF by duration of heart rhythm
Jabaudon D et al. Stroke. 2004351647-51.
4
Recurrence of AF 13 months post-stroke/TIA
60
50
40
AFrecurrence()
30
20
10
0
ECG or 24-hr Holter
7-day ELR
Jabaudon D et al. Stroke. 2004351647-51.
ELR 2-lead event-loop recording device
5
Clinical challenge Addressing the rising burden
of AF and stroke
AF continues to present an enormous public
health problem Men and women gt40 yrs have
lifetime risk for AF of 1 in 4 Estimated
2.2 million Americans May account for up to
140,000 strokes yearly ECG and 24-hr Holter
monitoring do not identify all stroke/TIA
patients with AF Many AF patients are not
receiving anticoagulant therapy to prevent
recurrent stroke
Lloyd-Jones DM et al. Circulation.
20041101042-6. AHA. Heart Disease and Stroke
Statistics2004 Update. Jabaudon D et al. Stroke.
2004351647-51.
6
Role of anticoagulant therapy in secondary
prevention of stroke
AF should be strongly suspected in all patients
with acute stroke/TIA or TIA All stroke/TIA
patients with confirmed AF should receive
anticoagulant therapy Warfarin Pro Proven
effective Con Need for frequent (and costly)
monitoring and dose adjustment New
anticoagulants that offer fixed dosing with no
monitoring are under investigation and may
address warfarins shortcomings Oral (direct
thrombin inhibitors, ie, ximelagatran)
Parenteral (lowmolecular-weight heparins,
factor Xa inhibitors)