Delayed atrial fibrillation diagnosis >6 months after cryptogenic stroke was significantly associated with an increased risk of recurrent stroke (HR 2.51; P=0.003).
Cohort (n=355)
Does delayed detection of atrial fibrillation increase the risk of recurrent ischemic stroke in adult patients with cryptogenic stroke?
Delayed detection of atrial fibrillation (>6 months) after cryptogenic stroke is associated with a 2.5-fold increased risk of recurrent stroke, emphasizing the importance of early and extended cardiac monitoring.
Hazard Ratio: 2.51
p-value: p=0.003
Abstract Background and Objectives: Cryptogenic stroke (CS) accounts for a significant percentage of ischemic strokes. Undetected atrial fibrillation (AF) is a major underlying cause, and delayed identification increases recurrence risk. This study evaluated the timing of AF detection after CS and its impact on stroke recurrence and secondary prevention in a tertiary care setting. Methods: This retrospective observational analysis comprised 355 adult patients with CS hospitalized from January 2020 to June 2024. Demographic data, AF detection, timing, monitoring options, anticoagulation status, and stroke recurrence were all recorded. A multivariable Cox regression analysis identified predictors of recurrent stroke. SPSS version 23.0 was used for analysis. Results: Among 355 CS patients, 115 (32.4%) were diagnosed with AF during the follow-up period. The median time to AF detection was 5.5 months. Modalities for detection included Holter monitoring 55 (47.8%), electrocardiography 48 (41.7%), and implantable loop recorders 12 (10.4%). Among those with AF, 34 (29.6%) suffered a recurrent stroke; only 12 (35.3%) were on anticoagulation at the time of recurrence. Independent predictors of recurrence included age >65 years (hazard ratio HR 2.29; P = 0.012), delayed AF diagnosis >6 months (HR 2.51; P = 0.003), non-adherence to anticoagulation (HR 3.59, P = 0.002), and left atrial enlargement (HR 2.31, P = 0.017). Conclusions: Delayed AF diagnosis in CS is prevalent and has been linked to a significantly greater risk of recurrent stroke. Early and extended cardiac monitoring, combined with early anticoagulation, is critical for improving patient outcomes in CS.
Shah et al. (Fri,) conducted a cohort in Cryptogenic stroke (n=355). Delayed atrial fibrillation diagnosis >6 months vs. Early atrial fibrillation diagnosis was evaluated on Recurrent stroke (HR 2.51, p=0.003). Delayed atrial fibrillation diagnosis >6 months after cryptogenic stroke was significantly associated with an increased risk of recurrent stroke (HR 2.51; P=0.003).