Younger Stroke Patients with Atrial Fibrillation Face Increased Risks, Study Finds
Spain: A two-decade cohort study published in the European Journal of Neurology has revealed a concerning association between atrial fibrillation (AF) and worse outcomes in young stroke patients. The study found that being diagnosed with atrial fibrillation at a younger age significantly increased the risk of ischemic stroke. Individuals diagnosed at age 55 had a 5.35-fold higher stroke risk compared to those diagnosed at age 85.
The researchers also revealed that stroke onset occurred 13.9 years earlier for those diagnosed with AF at 55, whereas it was only 1.5 years earlier for those diagnosed at 85. They wrote, "Among those diagnosed at 55, the stroke risk was highest when AF was diagnosed more than 10 years earlier, with a hazard ratio of 7.30. The findings emphasize the critical importance of early stroke prevention in younger AF patients."
Given the limited knowledge about the prevalence of atrial fibrillation in young stroke patients and its associated factors and outcomes, Patricia MartÃnez-Sánchez, Department of Neurology, Stroke Centre, Torrecárdenas University Hospital, AlmerÃa, Spain, and colleagues conducted an analysis to better understand these aspects.
For this purpose, the researchers conducted a retrospective analysis using the Spain Nationwide Minimum Basic Data Set (MBDS) from 2016 to 2020, focusing on ischemic stroke (IS) patients aged 18 to 50 years. Multivariate analyses were performed to identify factors associated with the diagnosis of atrial fibrillation in this population.
The study revealed the following findings:
- Among 11,615 young ischemic stroke patients, 426 (3.7%) were diagnosed with atrial fibrillation.
- Patients with AF were older, with a median age of 45 years than 44 years for those without AF.
- AF patients experienced more incapacitating symptoms, higher in-hospital complications, and were less likely to be discharged home.
- Multivariate analyses revealed several factors independently associated with a higher likelihood of AF: older age (OR 1.053), obstructive sleep apnea (OR 1.508), hyperthyroidism (OR 3.741), valvular heart disease (OR 6.094), congenital cardiopathies (OR 2.386), non-congenital cardiopathies (OR 4.446), and heart failure (OR 3.098).
- Factors associated with a lower likelihood of AF included female gender (OR 0.647), diabetes mellitus (OR 0.487), smoking (OR 0.617), patent foramen ovale (OR 0.210), and arterial dissection (OR 0.294).
The authors concluded that atrial fibrillation in young ischemic stroke patients is linked to more in-hospital complications and disabling strokes. They identified several factors associated with AF, including older age, obstructive sleep apnea, thyroid disorders, and heart conditions such as valvular heart disease and cardiomyopathies. Interestingly, they found that common risk factors for other IS causes, such as diabetes mellitus and smoking, were associated with a lower likelihood of AF diagnosis in this patient group.
"The findings underscore the importance of recognizing AF in young stroke patients, particularly those with risk factors like hyperthyroidism and cardiomyopathies," the researchers wrote. They emphasized the need for clinicians to assess these risk factors to ensure timely diagnosis and management of AF, ultimately improving outcomes for this demographic group.
Reference:
Garrido-Hernández, T., Amaya-Pascasio, L., Quesada-López, M., Arjona-Padillo, A., GarcÃa-Torrecillas, J. M., & MartÃnez-Sánchez, P. (2024). Atrial fibrillation in young stroke patients: Associated factors and outcomes in a nationwide analysis. European Journal of Neurology, 32(1), e16555. https://doi.org/10.1111/ene.16555
