학술논문
Potential missed opportunities to prevent ischaemic stroke: prospective multicentre cohort study of atrial fibrillation-associated ischaemic stroke and TIA
Document Type
article
Author
Gregory Y H Lip; Michael Power; Martin M Brown; Matthew Smith; Christopher Price; Tarek Yousry; Gargi Banerjee; David J Werring; Gareth Ambler; Michelle Davis; Chris Patterson; Keith Muir; Krishna Dani; Julie Staals; Jon Scott; Pankaj Sharma; Duncan Wilson; Clare Shakeshaft; Hannah Cohen; Kirsty Harkness; Louise Shaw; Jane Sword; Roland Veltkamp; Deborah Kelly; Frances Harrington; Marc Randall; Karim Mahawish; Abduelbaset Elmarim; Bernard Esisi; Claire Cullen; Arumug Nallasivam; Adrian Barry; Christine Roffe; John Coyle; Ahamad Hassan; Caroline Lovelock; Jonathan Birns; David Cohen; L Sekaran; Adrian Parry-Jones; Anthea Parry; David Hargroves; Harald Proschel; Prabel Datta; Khaled Darawil; Aravindakshan Manoj; Mathew Burn; Elio GialloMbardo; Nigel Smyth; Syed Mansoor; Ijaz Anwar; Rachel Marsh; Sissi Ispoglou; Dinesh Chadha; Mathuri Prabhakaran; Sanjeevikumar Meenakishundaram; Vinodh Krishnamurthy; Prasanna Aghoram; Michael McCormick; Nikola Sprigg Paul O’Mahony; Peter Wilkinson; Simon Leach; Sarah Caine; Ilse Burger; Gunaratam Gunathilagan; Paul Guyler; Hedley Emsley; Dulka Manawadu; Kath Pasco; Maam Mamun; Robert Luder; Mahmud Sajid; James Okwera; Elizabeth Warburton; Kari Saastamoinen; Timothy England; Janet Putterill; Enrico Flossman; David Mangion; Appu Suman; John Corrigan; Enas Lawrence; Djamil Vahidassr; Janice O’Connell; Mark White; Martin Cooper; Lillian Choy; David Seiffge; Andreas Charidimou; H R Jäger; Azlisham Mohd Nor; Al-Shahi Salman Rustam
Source
BMJ Open, Vol 9, Iss 7 (2019)
Subject
Language
English
ISSN
2044-6055
Abstract
Objective We report on: (1) the proportion of patients with known atrial fibrillation (AF); and (2) demographic, clinical or radiological differences between patients with known AF (and not treated) and patients with newly diagnosed AF, in a cohort of patients who presented with ischaemic stroke or transient ischaemic attack (TIA) not previously treated with anticoagulation.Design We reviewed cross-sectional baseline demographic and clinical data from a prospective observational cohort study, (CROMIS-2).Setting Patients were recruited from 79 hospital stroke centres throughout the UK and one centre in the Netherlands.Participants Patients were eligible if they were adults who presented with ischaemic stroke or TIA and AF and had not been previously treated with oral anticoagulation.Main outcome measures Proportion of patients with known AF before index ischaemic stroke or TIA from a cohort of patients who have not been previously treated with oral anticoagulation. Secondary analysis includes the comparison of CHA2DS2-VASc and HAS-BLED scores and other demographics and risk factors between those with newly diagnosed AF and those with previously known AF.Results Of 1470 patients included in the analysis (mean age 76 years (SD 10)), 622 (42%) were female; 999 (68%) patients had newly diagnosed AF and 471 (32%) patients had known AF. Of the 471 patients with known AF, 68% had a strong indication for anticoagulation and 89% should have been considered for anticoagulation based upon CHA2DS2-VASc score. Patients with known AF were more likely to have a prior history of dementia (4% vs 2%, p=0.02) and had higher HAS-BLED scores (median 3 vs 2). CHA2DS2-VASc, other risk factors and demographics were similar.Conclusions About 1/3 of patients who present with stroke and have AF who have not been treated with oral anticoagulation have previously known AF. Of these patients, at least 68% were not adequately treated with oral anticoagulation.Trial registration number NCT02513316.