Characteristics, outcome, and care of stroke associated with atrial fibrillation in Europe - Data from a multicenter multinational hospital-based registry (the European Community Stroke Project)

被引:316
作者
Lamassa, M
Di Carlo, A
Pracucci, G
Basile, AM
Trefoloni, G
Vanni, P
Spolveri, S
Baruffi, MC
Landini, G
Ghetti, A
Wolfe, CDA
Inzitari, D
机构
[1] Univ Florence, Dept Neurol & Psychiat Sci, I-50134 Florence, Italy
[2] Italian Longitudinal Study Aging, CSFET, CNR, Natl Res Council Italy, Florence, Italy
[3] Guys Kings Coll & St Thomas Hosp, Sch Med & Dent, Dept Publ Hlth Sci, London, England
关键词
atrial fibrillation; prognosis; stroke management; stroke outcome; stroke prevention;
D O I
10.1161/01.STR.32.2.392
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background ard Purpose-The role of atrial fibrillation (AF) as a determinant of stroke outcome is not well established. Studies focusing on this topic relied on relatively small samples of patients, scarcely representative of the older age groups. We aimed at evaluating clinical characteristics, can, and outcome of stroke associated with AF in a large European sample. Methods-In a European Concerted Action involving 7 countries, 4462 patients hospitalized for first-in-a-lifetime stroke were evaluated for demographics, risk factors, clinical presentation, resource use, and 3-month survival, disability (Barthel Index), and handicap (Rankin scale). Results-AF was present in 803 patients (18.0%). AF patients, compared with those without AF, were older, were more frequently female, and more often had experienced a previous myocardial infarction: they were less often diabetics, alcohol consumers, and smokers (all P<0.001). At 3 months, 32.8% of the AF patients level were dead compared with 19.9% of the non-AF patients (P<0.001). With control for baseline variables, AF increased by almost 50% the probability of remaining disabled (multivariate odds ratio 1.43, 95% CI 1.13 to 1.80) or handicapped (multivariate odds ratio 1.51, 95% CI 1.13 to 2.02). Before stroke, only 8.4% of AF patients were on anticoagulants. The chance of being anticoagulated was reduced by 4% per year of increasing age. AF patients underwent CT scan and other diagnostic procedures less frequently and received less physiotherapy or occupational therapy. Conclusions-Stroke associated with AF has a poor prognosis in terms of death and function. Prevention and care of stroke with AF is a major challenge for European health systems.
引用
收藏
页码:392 / 398
页数:7
相关论文
共 43 条
[1]   A PROSPECTIVE-STUDY OF ACUTE CEREBROVASCULAR-DISEASE IN THE COMMUNITY - THE OXFORDSHIRE-COMMUNITY-STROKE-PROJECT 1981-86 .1. METHODOLOGY, DEMOGRAPHY AND INCIDENT CASES OF 1ST-EVER STROKE [J].
BAMFORD, J ;
SANDERCOCK, P ;
DENNIS, M ;
WARLOW, C ;
JONES, L ;
MCPHERSON, K ;
VESSEY, M ;
FOWLER, G ;
MOLYNEUX, A ;
HUGHES, T ;
BURN, J ;
WADE, D .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 1988, 51 (11) :1373-1380
[2]   CLASSIFICATION AND NATURAL-HISTORY OF CLINICALLY IDENTIFIABLE SUBTYPES OF CEREBRAL INFARCTION [J].
BAMFORD, J ;
SANDERCOCK, P ;
DENNIS, M ;
BURN, J ;
WARLOW, C .
LANCET, 1991, 337 (8756) :1521-1526
[3]   Hospital services for stroke care - A European perspective [J].
Beech, R ;
Ratcliffe, M ;
Tilling, K ;
Wolfe, C .
STROKE, 1996, 27 (11) :1958-1964
[4]   NON-RHEUMATIC ATRIAL-FIBRILLATION AS A RISK FACTOR FOR STROKE [J].
BRITTON, M ;
GUSTAFSSON, C .
STROKE, 1985, 16 (02) :182-188
[5]   RELATIONSHIP OF CARDIAC DISEASE TO STROKE OCCURRENCE, RECURRENCE, AND MORTALITY [J].
BRODERICK, JP ;
PHILLIPS, SJ ;
OFALLON, WM ;
FRYE, RL ;
WHISNANT, JP .
STROKE, 1992, 23 (09) :1250-1256
[6]   Why do patients with atrial fibrillation not receive warfarin? [J].
Bungard, TJ ;
Ghali, WA ;
Teo, KK ;
McAlister, FA ;
Tsuyuki, RT .
ARCHIVES OF INTERNAL MEDICINE, 2000, 160 (01) :41-46
[7]   MORTALITY IN ACUTE STROKE WITH ATRIAL-FIBRILLATION [J].
CANDELISE, L ;
PINARDI, G ;
MORABITO, A .
STROKE, 1991, 22 (02) :169-174
[8]   INCIDENCE AND PROGNOSIS OF STROKE IN THE VALLE-DAOSTA, ITALY - 1ST-YEAR RESULTS OF A COMMUNITY-BASED STUDY [J].
DALESSANDRO, G ;
DIGIOVANNI, M ;
ROVEYAZ, L ;
IANNIZZI, L ;
COMPAGNONI, MP ;
BLANC, S ;
BOTTACCHI, E .
STROKE, 1992, 23 (12) :1712-1715
[9]   Stroke in the very old - Clinical presentation and determinants of 3-month functional outcome: A European perspective [J].
Di Carlo, A ;
Lamassa, M ;
Pracucci, G ;
Basile, AM ;
Trefoloni, G ;
Vanni, P ;
Wolfe, CDA ;
Tilling, K ;
Ebrahim, S ;
Inzitari, D .
STROKE, 1999, 30 (11) :2313-2319
[10]   Predictors of acute hospital costs for treatment of ischemic stroke in an academic center [J].
Diringer, MN ;
Edwards, DF ;
Mattson, DT ;
Akins, PT ;
Sheedy, CW ;
Hsu, CY ;
Dromerick, AW .
STROKE, 1999, 30 (04) :724-728