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High Prevalence of Atrial Fibrillation in a Lithuanian Stroke Patient Cohort

Background and Objectives: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a five-fold increased risk for acute ischemic stroke (AIS). We aimed to estimate the prevalence of AF in a Lithuanian cohort of stroke patients, and its impact on patients regarding case...

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Autores principales: Masiliūnas, Rytis, Dapkutė, Austėja, Grigaitė, Julija, Lapė, Jokūbas, Valančius, Domantas, Bacevičius, Justinas, Katkus, Rimgaudas, Vilionskis, Aleksandras, Klimašauskienė, Aušra, Ekkert, Aleksandra, Jatužis, Dalius
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9230037/
https://www.ncbi.nlm.nih.gov/pubmed/35744063
http://dx.doi.org/10.3390/medicina58060800
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author Masiliūnas, Rytis
Dapkutė, Austėja
Grigaitė, Julija
Lapė, Jokūbas
Valančius, Domantas
Bacevičius, Justinas
Katkus, Rimgaudas
Vilionskis, Aleksandras
Klimašauskienė, Aušra
Ekkert, Aleksandra
Jatužis, Dalius
author_facet Masiliūnas, Rytis
Dapkutė, Austėja
Grigaitė, Julija
Lapė, Jokūbas
Valančius, Domantas
Bacevičius, Justinas
Katkus, Rimgaudas
Vilionskis, Aleksandras
Klimašauskienė, Aušra
Ekkert, Aleksandra
Jatužis, Dalius
author_sort Masiliūnas, Rytis
collection PubMed
description Background and Objectives: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a five-fold increased risk for acute ischemic stroke (AIS). We aimed to estimate the prevalence of AF in a Lithuanian cohort of stroke patients, and its impact on patients regarding case fatality, functional outcome, and health-related quality of life (HRQoL) at 90 days. Materials and Methods: A single-center prospective study was carried out for four non-consecutive months between December 2018 and July 2019 in one of the two comprehensive stroke centers in Eastern Lithuania. A telephone-based follow-up was conveyed at 90 days using the modified Rankin Scale (mRS) and EuroQoL five-dimensional three-level descriptive system (EQ-5D-3L) with a self-rated visual analog scale (EQ-VAS). One-year case fatality was investigated. Results: We included 238 AIS patients with a mean age of 71.4 ± 11.9 years of whom 45.0% were female. A striking 97 (40.8%) AIS patients had a concomitant AF, in 68 (70.1%) of whom the AF was pre-existing. The AIS patients with AF were at a significantly higher risk for a large vessel occlusion (LVO; odds ratio 2.72 [95% CI 1.38–5.49], p = 0.004), and had a more severe neurological impairment at presentation (median NIHSS score (interquartile range): 9 (6–16) vs. 6 (3–9), p < 0.001). The LVO status was only detected in those who had received computed tomography angiography. Fifty-five (80.9%) patients with pre-existing AF received insufficient anticoagulation at stroke onset. All patients received a 12-lead ECG, however, in-hospital 24-h Holter monitoring was only performed in 3.4% of AIS patients without pre-existing AF. Although multivariate analyses found no statistically significant difference in one-year stroke patient survival and favorable functional status (mRS 0–2) at 90 days, when adjusted for age, gender, reperfusion treatment, baseline functional status, and baseline NIHSS, stroke patients with AF had a significantly poorer self-perceived HRQoL, indicated by a lower EQ-VAS score (regression coefficient ± standard error: β = −11.776 ± 4.850, p = 0.017). Conclusions: In our single-center prospective observational study in Lithuania, we found that 40.8% of AIS patients had a concomitant AF, were at a higher risk for an LVO, and had a significantly poorer self-perceived HRQoL at 90 days. Despite the high AF prevalence, diagnostic tools for subclinical AF were greatly underutilized.
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spelling pubmed-92300372022-06-25 High Prevalence of Atrial Fibrillation in a Lithuanian Stroke Patient Cohort Masiliūnas, Rytis Dapkutė, Austėja Grigaitė, Julija Lapė, Jokūbas Valančius, Domantas Bacevičius, Justinas Katkus, Rimgaudas Vilionskis, Aleksandras Klimašauskienė, Aušra Ekkert, Aleksandra Jatužis, Dalius Medicina (Kaunas) Article Background and Objectives: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a five-fold increased risk for acute ischemic stroke (AIS). We aimed to estimate the prevalence of AF in a Lithuanian cohort of stroke patients, and its impact on patients regarding case fatality, functional outcome, and health-related quality of life (HRQoL) at 90 days. Materials and Methods: A single-center prospective study was carried out for four non-consecutive months between December 2018 and July 2019 in one of the two comprehensive stroke centers in Eastern Lithuania. A telephone-based follow-up was conveyed at 90 days using the modified Rankin Scale (mRS) and EuroQoL five-dimensional three-level descriptive system (EQ-5D-3L) with a self-rated visual analog scale (EQ-VAS). One-year case fatality was investigated. Results: We included 238 AIS patients with a mean age of 71.4 ± 11.9 years of whom 45.0% were female. A striking 97 (40.8%) AIS patients had a concomitant AF, in 68 (70.1%) of whom the AF was pre-existing. The AIS patients with AF were at a significantly higher risk for a large vessel occlusion (LVO; odds ratio 2.72 [95% CI 1.38–5.49], p = 0.004), and had a more severe neurological impairment at presentation (median NIHSS score (interquartile range): 9 (6–16) vs. 6 (3–9), p < 0.001). The LVO status was only detected in those who had received computed tomography angiography. Fifty-five (80.9%) patients with pre-existing AF received insufficient anticoagulation at stroke onset. All patients received a 12-lead ECG, however, in-hospital 24-h Holter monitoring was only performed in 3.4% of AIS patients without pre-existing AF. Although multivariate analyses found no statistically significant difference in one-year stroke patient survival and favorable functional status (mRS 0–2) at 90 days, when adjusted for age, gender, reperfusion treatment, baseline functional status, and baseline NIHSS, stroke patients with AF had a significantly poorer self-perceived HRQoL, indicated by a lower EQ-VAS score (regression coefficient ± standard error: β = −11.776 ± 4.850, p = 0.017). Conclusions: In our single-center prospective observational study in Lithuania, we found that 40.8% of AIS patients had a concomitant AF, were at a higher risk for an LVO, and had a significantly poorer self-perceived HRQoL at 90 days. Despite the high AF prevalence, diagnostic tools for subclinical AF were greatly underutilized. MDPI 2022-06-14 /pmc/articles/PMC9230037/ /pubmed/35744063 http://dx.doi.org/10.3390/medicina58060800 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Masiliūnas, Rytis
Dapkutė, Austėja
Grigaitė, Julija
Lapė, Jokūbas
Valančius, Domantas
Bacevičius, Justinas
Katkus, Rimgaudas
Vilionskis, Aleksandras
Klimašauskienė, Aušra
Ekkert, Aleksandra
Jatužis, Dalius
High Prevalence of Atrial Fibrillation in a Lithuanian Stroke Patient Cohort
title High Prevalence of Atrial Fibrillation in a Lithuanian Stroke Patient Cohort
title_full High Prevalence of Atrial Fibrillation in a Lithuanian Stroke Patient Cohort
title_fullStr High Prevalence of Atrial Fibrillation in a Lithuanian Stroke Patient Cohort
title_full_unstemmed High Prevalence of Atrial Fibrillation in a Lithuanian Stroke Patient Cohort
title_short High Prevalence of Atrial Fibrillation in a Lithuanian Stroke Patient Cohort
title_sort high prevalence of atrial fibrillation in a lithuanian stroke patient cohort
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9230037/
https://www.ncbi.nlm.nih.gov/pubmed/35744063
http://dx.doi.org/10.3390/medicina58060800
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