Characteristics of patients with asymptomatic atrial fibrillation and Ischemic stroke: insights from the GLORIA-AF registry (Phase 2)

Abstract

Background: Asymptomatic nonvalvular atrial fibrillation is often suspected in patients with cryptogenic stroke which constitute20%–30% of ischemic strokes. Detection of atrial fibrillation (AF) and treatment with anticoagulation can reduce the risk of stroke.We sought to investigate the prevalence of asymptomatic atrial fibrillation (aAF) in patients with a history of stroke or an acutestroke on admission.Methods: From November 2011 until December 2014, 15,308 patients with a first episode of AF were enrolled in phase 2 of theinternational, prospective, multicenter global registry on long-term oral anticoagulation treatment in patients with AF (GLORIA-AF) Registry. For the present analysis, we focused on patients with aAF regarding the prevalence of stroke.Results: One third of patients (n = 4892, 32%) had aAF. Of these, 611 (12.5%) had a history of stroke or an acute stroke on admission.In contrast, 519 of 10,416 (5.0%) patients with symptomatic AF (sAF) had a history of stroke or an acute stroke on admission. Higherage, male gender, permanent AF, stroke, and the combination of stroke, TIA or systemic embolism were associated with a higherprevalence of aAF on admission. In a multivariable analysis, patients with aAF had a 2.3-fold (95% confidence interval (CI), 2.02–2.54) risk for stroke compared to patients with sAF. Other independent risk factors for stroke were a history of prior bleeding (oddsratio 1.62, 95% CI, 1.34–1.92), chronic kidney disease (1.38, 1.21–1.56), and diabetes mellitus (1.24, 1.10–1.41).