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Stroke history higher in asymptomatic versus symptomatic atrial fibrillation patients
Newly diagnosed asymptomatic atrial fibrillation patients
have a higher rate of previous stroke than those with
symptoms, according to results from the GLORIA-AF
registry presented recently at EHRAEuropace – CardioSTIM
2017. The findings highlight the need for screening to identify
atrial fibrillation patients with no symptoms so that stroke
prevention treatment can be given.
‘Patients with non-valvular atrial fibrillation have a five-
fold increased risk of stroke compared to those without
atrial fibrillation,’ said lead author Dr Steffen Christow,
a cardiologist at Hospital Ingolstadt GmbH, Ingolstadt,
Germany. ‘Strokes in patients with non-valvular atrial
fibrillation tend to be particularly severe and disabling, with
about half of patients dying within one year.’
‘Appropriate anticoagulant therapy substantially reduces the
risk of stroke, but in many cases non-valvular atrial fibrillation
is only diagnosed after a patient has had a stroke,’ he continued.
‘When patients are unaware of their atrial fibrillation they
remain untreated and unprotected from stroke.’
GLORIA-AF (Global Registry on Long-Term Oral
Antithrombotic Treatment in Patients with Atrial Fibrillation)
is a large, multinational, prospective registry programme
involving patients with newly diagnosed non-valvular atrial
fibrillation. This sub-analysis compared characteristics between
symptomatic and asymptomatic patients in Western Europe.
The study included 6 011 consecutively enrolled patients
with non-valvular atrial fibrillation in Western Europe.
Symptom status was defined by the European Heart Rhythm
Association (EHRA) score: I–II asymptomatic/minimally
symptomatic; III–IV symptomatic.
A total of 4 119 patients (two-thirds) were asymptomatic/
minimally symptomatic (hereafter referred to as
‘asymptomatic’) and one-third (1 892) were symptomatic at
the time of diagnosis. A number of differences were observed
between the two groups.
In terms of medical history, asymptomatic patients were
twice as likely to have permanent atrial fibrillation (15.8 vs
8.3%) and more than twice as likely to have had a previous
stroke (14.7 vs 6.0%) than patients in the symptomatic group.
Asymptomatic and symptomatic patients had a similar
number of stroke risk factors, as indicated by a CHA
2
DS
2
-
VASc score of 3.3 in each group.
Dr Christow said: The finding of a higher rate of previous
stroke in the asymptomatic patients despite no differences
in the number of stroke risk factors may be explained by a
longer but undiagnosed history of atrial fibrillation.’
‘Our study found that in Western Europe, two-thirds
of patients newly diagnosed with atrial fibrillation were
asymptomatic,’ he continued. ‘Without detection, patients
may not receive appropriate preventive therapy and remain
at increased risk of stroke.’
Dr Christow concluded: ‘These results underline the
urgent need for public programmes to detect atrial fibrillation
in the general population.’
Source
: European Society of Cardiology Press Office