Neurologic events in patients with atrial fibrillation: outcome and prevention practices

Background: Atrial fibrillation (AF) is associated with neurologic events (transient ischemic attack (TIA) and stroke). The objective of the present study was to determine the outcome of patients with neurological events and atrial fibrillation (AF) in comparison with patients in sinus rhythm (SR), and to investigate the primary and secondary prevention practices in patients with neurological events and AF. Patients and methods: In a prospective, observational, single center study in a large public, university-affiliated hospital all patients admitted between 1/97 and 1/98 with acute neurologic events were registered (n = 369). The association between outcome of neurologic events as assessed by survival status, functional status (Rankin scale) and severity of event (European Stroke Scale) and heart rhythm was investigated by use of logistic regression. Antithrombotic medication on admission and at discharge was recorded. Results: The mean age of the 369 patients was 75.1+/-10.9 years; 56.1% were female. A TIA was present in 26.2% and stroke in 73.8%. 287 patients (77.8%) were in SR and 82 in AF on admission (22.2%). In-hospital mortality was 12.7% in all patients. In patients with AE mortality was 23.2% and 9.8% in patients with SR (p = 0.0013). Patients with AF were significantly older than patients with SR (80.4+/-7.5 versus 73.5+/-11.2 years; p<0.001). Multivariate analysis identified heart rhythm as an independent predictor of survival (p<0.01). Patients with AF did suffer from a more severe neurological deficit on admission and at discharge than patients with SR. In 46.3% of patients with AF severe dependency was present (Rankin 4/5), while this was the case in 28.5% of patients with SR (p<0.01). The ESS score of patients with AF was 77.4+/-30.6 at discharge compared to 88.1+/-20.3 in patients with SR (p<0.01). In 50 of 82 patients (61%) AF was previously known. Of these 50 patients 36% did not receive any kind of antithrombotic treatment and only 12% were receiving oral anticoagulants before the event. Of 63 surviving patients with AF 32 did not have any contraindications against anticoagulation treatment. At discharge, 14 (43.8%) of these patients were receiving oral anticoagulants, 17 aspirin or ticlopidine (53.1%) and 1 patient (3.1%) no type of antithrombotic medication. Conclusions: Neurologic events in patients with AF are more severe and outcome is significantly poorer than in patients with SR. Anticoagulation as the effective therapy for primary and secondary prevention of neurologic events is seriously underused in daily practice.