Jul 2026· International Journal of Cardiology: Heart & Vasculature· Vol 65, pp. 101964· 1 citation· 30 references
Medicine
TL;DR
PAFIS provides a simple AFDAS-specific tool for selective post-stroke rhythm monitoring and outperformed CHA₂DS₂-VASc, HAVOC, and AF-ESUS, but not Brown ESUS-AF.
Abstract
Background Atrial fibrillation detected after stroke (AFDAS) is clinically important, but AFDAS-specific risk tools for patients without known atrial fibrillation (AF) remain limited. We developed and temporally validated the Prediction of AF in Ischemic Stroke (PAFIS) score. Methods We retrospectively analyzed ischemic-stroke patients from the National Taiwan University Hospital Integrative Medical Data Center. The development cohort included patients hospitalized in 2010–2020 (n = 3406), and the temporal validation cohort included those hospitalized in 2021–2023 (n = 1366). Known AF (KAF) was defined as AF documented before stroke or within 14 days after stroke; AFDAS was defined as newly documented AF beyond 14 days among patients without KAF. Multivariable logistic regression restricted to KAF-free patients was used for score derivation. Discrimination, calibration, and time-to-AFDAS risk stratification were assessed. Results Among KAF-free patients, AFDAS was detected during routine clinical follow-up in 176 of 2175 (8.1%) in the development cohort and 148 of 1366 (10.8%) in the validation cohort. The final PAFIS score included age ≥ 75 years, female sex, valvular heart disease, left atrial diameter ≥ 40 mm, and tricuspid regurgitation peak gradient ≥30 mmHg. AUCs were 0.72 (95% CI, 0.68–0.76) in development and 0.65 (95% CI, 0.60–0.70) in validation. PAFIS outperformed CHA₂DS₂-VASc, HAVOC, and AF-ESUS, but not Brown ESUS-AF. Observed AFDAS detection rates increased across risk groups in both cohorts. Conclusions PAFIS provides a simple AFDAS-specific tool for selective post-stroke rhythm monitoring. Because AF ascertainment was based on routine clinical care without standardized prolonged monitoring, PAFIS predicts AF detection under routine practice rather than true AFDAS incidence. Prospective multicenter validation with standardized monitoring is warranted.
Background: Atrial fibrillation detected after stroke (AFDAS) is frequently diagnosed after embolic stroke of undetermined source (ESUS) and has important implications for secondary stroke prevention. Although prediction scores have been proposed to identify patients at increased risk of AFDAS, prospective evidence supporting their implementation to guide rhythm monitoring in routine clinical practice is limited. Methods: In this prospective, population-based implementation cohort study, adults with ESUS were enrolled between January 2022 and December 2024 across all stroke centers in Styria, Austria. The Graz AF Risk Score was prospectively implemented as part of a risk-adapted diagnostic pathway for cardiac rhythm monitoring. Patients with a score [≥]4 were recommended for implantable loop recorder monitoring, whereas monitoring in those with scores <4 remained at the treating physician's discretion. The primary outcome was AFDAS detection; recurrent ischemic stroke and recurrent stroke etiology were secondary outcomes. Results: Among 784 patients (median age 73 years [IQR 64-80], 45.7% women), AFDAS was detected in 166 patients (21.2%) during a median follow-up of 26.3 months (IQR 20-34). AFDAS detection was substantially higher in patients with a Graz AF Risk Score [≥]4 than <4 (38.1% vs. 3.9%; p<0.001). After adjustment for age, sex and ILR monitoring, a score [≥]4 independently predicted AFDAS (HR 6.3, 95% CI 3.5-11.2; p<0.001) and recurrent ischemic stroke (HR 2.2, 95% CI 1.1-4.1; p=0.023). Only one recurrent stroke in patients with a score <4 was attributable to atrial fibrillation (AF) (1/18, 5.6%). Conclusions: Prospective implementation of the Graz AF Risk Score identified patients with ESUS at markedly different risks of AFDAS. A Graz AF Risk Score [≥]4 was also independently associated with recurrent ischemic stroke. These findings support a risk-adapted approach to cardiac rhythm monitoring after ESUS.
J. Elbischger, A. Krainer, T. Ruprechter et al.· medRxiv· 0 citations
The CHA2DS2-VALa score significantly improves stroke risk stratification in AF by integrating LA diameter into conventional scoring, as echocardiographic measurement is widely available and reproducible.
Sefa Erdi Ömür, Emin Koyun, Gülşen Genç Tapar et al.· Cardiovascular Electrophysio...· 0 citations
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.
G. Duan, Xiaoguang Zhu, Jiangshan Deng et al.· Frontiers in Cardiovascular...· 0 citations
In patients with cryptogenic stroke receiving an ICM, the ECG-AI score showed modest discrimination for AF detection, outperforming CHA2DS2-VA and HAVOC, but not Brown ESUS-AF, which indicates a possible role for AI-driven ECG analysis in risk stratification.
F. Wouters, M. Barthels, J. Vranken et al.· Digital Health· 0 citations
External validation of the GLORIA-AF Stroke Weighted Risk Score supports its transportability and potential adjunctive role in guideline-directed thromboembolic risk assessment and generally greater net benefit than CHA2DS2-VA.
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
We use cookies to run the site and, with your consent, for analytics and to show ads.
See our Cookie Policy.
