Should screening for atrial fibrillation in stroke patients be more thorough?

This study looked at whether late diagnosis of atrial fibrillation in stroke patients would result in a higher chance of another stroke. The authors concluded that delayed diagnosis of atrial fibrillation resulted in a higher risk of recurrent stroke, particularly in men.

Atrial fibrillation (AF) is when a patient has an irregular heartbeat that can lead to a blood clot or heart failure. Ischemic strokes (IS) occur when blood flow from the brain is restricted due to a blocked blood vessel. Therefore, AF is a major risk factor for IS. Furthermore, it is also a risk factor for recurrent stroke and can result in worse outcomes for stroke patients.

AF, however, may be asymptomatic (no symptoms), and the stroke itself can be the first obvious symptom. It is possible that diagnosing AF late after initial stroke could lead to further strokes. If this is the case, more extensive screening for AF in stroke patients could be necessary.

This study aimed to evaluate the link between the timing of AF diagnosis after stroke and patient clinical outcome.

The authors identified 17,399 patients admitted for first-ever stroke and grouped them into 3 groups. Group 1 consisted of 16,261 patients who did not have AF. Group 2 included 907 patients who were diagnosed with AF upon initial hospital admission for stroke. Group 3 consisted of 231 patients who were diagnosed with AF within the first year after stroke.

After 5 years, 17.33% of patients had a recurrent stroke. Of these, 17.1% were from group 1, 19.3% were from group 2 and 29.4% were from group 3.

The risk of recurrent stroke in patients without AF was 21% lower than for patients with AF. The mortality risk from recurrent stroke was also 59% lower for patients without AF compared to those with.

The risk of recurrent stroke for group 3 patients was 57% higher than for group 2 patients. This was specific for males.

The authors concluded that delayed diagnosis of AF after stroke increased the risk of recurrent stroke, particularly in males.

Discuss with your doctor whether or not you should be screened for atrial fibrillation.