Aug 2026· Frontiers in Cardiovascular Medicine· Vol 13· 0 citations· 22 references
Medicine
TL;DR
AAF at the onset of AIS is an independent risk predictor for early neurological deterioration and short-term mortality, establishing it as a crucial prognostic indicator that warrants vigilant management.
Abstract
Background Atrial fibrillation (AF) is an important risk factor for ischemic stroke. However, the prognostic impact of acute atrial fibrillation (AAF) at the onset of acute ischemic stroke (AIS) remains unclear. Methods This retrospective study categorized 417 patients with AIS into the AAF (n = 72), other AF (n = 142), and non-AF (n = 203) groups. Multivariate logistic regression analysis of associations with 30-day all-cause mortality and severe early neurological deficit (7-day NIHSS ≥16). Results The AAF group demonstrated significantly worse outcomes than the other AF and non-AF groups. In the multivariable analysis, AAF was identified as an independent risk predictor for severe 7-day neurological deficit [odds ratio (OR): 10.09; 95% CI: 3.87−27.36; P < 0.001] and all-cause mortality within 30 days (OR: 4.11; 95% CI: 2.28−7.43; P < 0.001). Conclusions AAF at the onset of AIS is an independent risk predictor for early neurological deterioration and short-term mortality, establishing it as a crucial prognostic indicator that warrants vigilant management.
BACKGROUND
Ischemic stroke patients with atrial fibrillation (AF) may have different mechanisms and prognostic determinants than those without AF. We investigated predictors of initial stroke severity and 3-month functional outcome in first-ever ischemic stroke, stratified by AF status.
METHODS
Consecutive patients with first-ever acute ischemic stroke admitted within 7 days of onset to Taitung MacKay Memorial Hospital from December 31, 2014, to December 31, 2020, were analyzed. Admission National Institutes of Health Stroke Scale (NIHSS) and 3-month modified Rankin Scale (mRS) scores were evaluated using multivariable general linear models stratified by AF status. The 3-month mRS models assessed whether associations persisted after adjustment for admission NIHSS.
RESULTS
Overall, 1256 patients were included (non-AF, n = 955; AF, n = 301). Patients with AF were older and had higher admission NIHSS and 3-month mRS scores than those without AF. In the non-AF group, age ≥75 years, betel nut chewing, and sedentary lifestyle were associated with higher admission NIHSS, whereas dyslipidemia was associated with lower admission NIHSS. In the AF group, sedentary lifestyle was associated with higher admission NIHSS, whereas obesity and pre-stroke anticoagulant therapy were associated with lower admission NIHSS. After adjustment for admission NIHSS, type 2 diabetes was independently associated with higher 3-month mRS in both groups. Age ≥75 years and sedentary lifestyle remained associated with higher 3-month mRS only in the non-AF group.
CONCLUSION
Predictors of initial stroke severity and 3-month functional outcome differ by AF status. Stratified prognostic assessment may guide individualized secondary prevention and post-stroke management.
Meng-Ying Lu, Kuo-Hua Hung, Chih-Ming Hu et al.· Journal of the Formosan Medi...· 0 citations
BACKGROUND
Atrial fibrillation (AF) is common in patients with aortic stenosis (AS), but its independent long-term prognostic impact on outcomes remains uncertain. We examined the association between AF and mortality risk across the full spectrum of AS.
METHOD
In this retrospective cohort study, we included 1592 patients with at least mild AS and preserved left ventricular ejection fraction (≥50%). Patients were stratified by AF status. Primary and secondary end points were all-cause and cardiovascular mortality, respectively.
RESULTS
Of 1592 patients, including the full spectrum of AS severity, 254 (16%) had AF. AF was more prevalent in patients with severe paradoxical low-flow low-gradient (36%) compared with severe normal-flow (12%), severe high-gradient (10%), and mild-to-moderate (16%) AS (P<0.001). During a median follow-up of 7.2 (interquartile range, 3.6-11.0) years, 885 deaths occurred (49% cardiovascular-related). AF was associated with an increased risk of all-cause and cardiovascular mortality (both P<0.001). In multivariable Cox models, AF independently predicted a higher risk of all-cause (hazard ratio [HR], 1.78 [95% CI, 1.34-2.36], P<0.001) and cardiovascular (HR, 1.77 [95% CI, 1.20-2.62], P=0.004) mortality. The prognostic impact was greatest for permanent/persistent AF (HR, 2.04) and significant for paroxysmal AF (HR, 1.69). The association of AF with outcomes remained consistent across various subgroups, including AS flow-gradient patterns (all interaction P>0.05).
CONCLUSION
In this large cohort with AS, AF was independently associated with an increased risk of both all-cause and cardiovascular mortality, regardless of treatment strategy or AS flow-gradient pattern. AF should be integrated into risk stratification algorithms in AS, beyond parameters of AS severity.
Thomas Reed-Métayer, Pier-Anthony Bouchard, Sébastien Hecht et al.· Journal of the American Hear...· 0 citations
Atrial fibrillation (AF) is the most prevalent sustained arrhythmia worldwide. Acute myocardial infarction (AMI) is closely intertwined with AF through a bidirectional relationship: pre-existing AF is associated with increased risk of AMI, while AMI predisposes to new-onset atrial fibrillation (NOAF). This narrative review synthesizes evidence on the global burden of AF in the setting of AMI: pre-existing AF, NOAF following AMI, and the prognostic implications of AF in AMI, encompassing the 'past, present and future' of AF in AMI. Pre-existing AF is present in 3%-4% of patients with AMI and has demonstrated an independent association with acute coronary syndromes, mediated by systemic inflammation, prothrombotic states, demand ischemia, and coronary thromboembolism. NOAF complicates 5%-20% of AMI cases, with peak onset within the first six months. Predictive factors include age, comorbidities such as chronic kidney disease, markers of inflammation (including systemic immune-inflammation index and hs-CRP), neurohormonal activation (NT-proBNP), echocardiographic parameters of diastolic dysfunction and left atrial strain, and electrocardiographic features such as QRS fragmentation. Multiple predictive models for NOAF have been developed with varying discriminatory performance. Emerging research suggests that machine learning may provide superior risk stratification, though further study is needed. AF in the context of AMI confers substantially increased risk of mortality, stroke, bleeding, and heart failure, with NOAF showing particularly strong prognostic significance. Improved recognition of predictive markers, alongside development of tailored prognostic models, is essential to guide antithrombotic therapy and optimize outcomes in this high-risk population.
E. Xiong, S. Prasad, John J. Atherton et al.· Pacing and clinical electrop...· 0 citations
New-onset atrial fibrillation (AF) is common among acutely hospitalized patients and is associated with increased risks of stroke and mortality. However, anticoagulation in this setting involves a temporal tradeoff between early bleeding during recovery and potential long-term stroke prevention, and data guiding direct oral anticoagulant (DOAC) initiation at discharge remain limited. We conducted a retrospective cohort study of adults with newly diagnosed AF identified between 3 days before hospital admission and hospital discharge within the Baylor Scott & White Health system (July 2020-June 2024), comparing patients initiated on DOAC therapy at discharge with those who were not. Outcomes included major adverse cardiovascular events (MACE: all-cause death, non-fatal myocardial infarction, or ischemic stroke/transient ischemic attack) and net adverse clinical events (NACE: MACE or major bleeding) at 30 days and 3 years. Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs), and landmark cumulative incidence analyses assessed temporal trends after discharge. Among 16,641 patients (mean age 75.1 years; 41.8% women), 7,181 (43.2%) were discharged on a DOAC. In adjusted analyses, DOAC use was associated with lower risk of 3-year MACE (HR 0.61; 95% CI 0.58-0.65; p<0.001) and NACE (HR 0.64; 95% CI 0.61-0.68; p<0.001) compared with those not receiving DOAC therapy. Landmark analyses showed consistent reductions in MACE at both 30 days (HR 0.61; 95% CI 0.57-0.65) and 3 years (HR 0.68; 95% CI 0.62-0.74). Patients treated with DOACs had a lower risk of NACE at both 30 days (HR 0.65; 95% CI 0.61-0.69) and 3 years (HR 0.67; 95% CI 0.62-0.73). Overall, DOAC initiation at discharge in patients with newly diagnosed AF identified between 3 days before hospital admission and hospital discharge was associated with lower early and long-term ischemic risk, with lower rates of both MACE and NACE observed at 30 days and 3 years, underscoring the need for individualized decision-making regarding anticoagulation during acute hospitalization.
Matthew Cervantes, Tariq Jamal Siddiqi, Anand Gupta et al.· American Journal of Cardiolo...· 0 citations
The occurrence of NOAF was associated with increased in-hospital mortality, which was 2–3 times higher in patients with arrhythmia, and most NOAF prediction models developed specifically in STEMI cohorts undergoing PCI demonstrated higher discriminative ability.
R. L. Pak, B. I. Geltser, E. Kokarev et al.· Siberian Journal of Clinical...· 0 citations
BACKGROUND
Depression is common in atrial fibrillation (AF) and related to adverse prognosis. Early rhythm control (ERC) has been shown to improve cardiovascular outcomes in AF; however, its impact on depression, remains less understood.
OBJECTIVE
To investigate the association between ERC and the risk of depression onset or worsening.
METHOD
We analyzed 533,328 AF patients from the National Health Information Database, categorized by prior depression (Group A: without; Group B: with). According to the ERC status (the initiation of rhythm control within one year of AF diagnosis), we evaluated new-onset depression in Group A and hospital admission for depression-related/any psychiatric condition in Group B.
RESULT
Of the total, 349,804 (65.6%) were Group A (mean age 62.8 years; male 63.8%), and 183,524 (34.4%) were Group B (mean age 65.6 years; male 45.8%). The proportion of patients receiving ERC was 30.1% in Group A and 27.7% in Group B. In Group A, ERC was associated with a lower risk of new-onset depression: adjusted HR (aHR) with 95% confidence interval (CI)=0.963 (0.946-0.980), p<0.001. In Group B, ERC was associated with a lower risk of hospital admission for depression as a principal diagnostic code [aHR (95% CI)=0.714 (0.619-0.822), p<0.001], depression listed among the top-five diagnostic codes [aHR (95% CI)=0.812 (0.777-0.848), p<0.001], and any psychiatric condition [aHR (95% CI)=0.652 (0.605-0.703), p<0.001] than usual care group. The lower risk of hospital admission for depression associated with ERC was more pronounced among younger (<65 years) and male AF patients.
CONCLUSION
ERC is associated with a lower risk of depression onset or worsening in patients with AF.
H. Ahn, So-Ryoung Lee, Bongseong Kim et al.· Heart Rhythm· 0 citations
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