On the outcome in stroke patients one year later: the role of atrial fibrillation

Strokes in paroxysmal atrial fibrillation have more favorable outcome than in permanent atrial fibrillation

OBJECTIVE

Our aim was to compare the course of IS due to ptAF and pxAF.

METHODS

A prospective, single-center study was conducted in patients with AF and acute IS with 6-month follow-up.

RESULTS

We included 178 patients: 70 (39%) with pxAF and 108 (61%) with ptAF. Compared with patients with ptAF, patients with pxAF more often presented with subcortical, mainly lacunar strokes (21% vs 8%, P = 0.01) and were less frequently dependent at discharge (16% vs 42%, P < 0.001) and after 6 months (16% vs 20%, P < 0.001). Strokes in patients with pxAF were more frequently categorized as non-cardioembolic (35% vs 18%, P = 0.01). In the multivariate analysis, after adjustment for confounding factors (diabetes, chronic heart failure, high risk of thromboembolism and lack of prestroke anticoagulation), ptAF was an important risk factor for unfavorable short-term (OR 5.4; P < 0.01) and long-term outcomes (OR 2.6, P = 0.01) of IS. In all patients with AF, the occurrence of non-cardioembolic stroke was related to a reduced risk of dependence or death in short-term outcome (OR 0.4, P = 0.04) and marginally influenced long-term outcome (OR 0.49, P = 0.09).

CONCLUSIONS

The present study suggests that, compared with patients with ptAF, ISs in patients with pxAF have better outcomes.

Death or improvement: the fate of highly disabled patients after stroke rehabilitation

The study evaluates the long-term outcome in patients severely disabled after suffering their first stroke and who after rehabilitation were discharged. A total of 176 consecutive patients were studied who at their discharge were highly dependent and presented a functional independence measure (FIM) score in the range of 18-39. They were discharged within 60 days, according to local laws. At a follow-up after 1 year, 89 patients survived (50.56%) and 72 (40.90%) died. One woman did not show up at the follow-up; 14 patients were not found (7.95%). By applying the Friedman's test a significant improvement was observed in stroke survivors. A significant negative correlation was found between age and FIM only at follow-up. In conclusion, highly disabled stroke patients are likely to undergo unfavorable outcome, but unexpected improvement cannot be ruled out.