High Prevalence of Atrial Fibrillation in a Lithuanian Stroke Patient Cohort

Prevalence and Risk Factors of Stroke in Patients with Nonvalvular Atrial Fibrillation: A Case-Control Study

OBJECTIVE

To analyze the prevalence and influencing factors of stroke in patients with nonvalvular atrial fibrillation (SIPWNVAF), and to provide a reference basis for the prevention and control of stroke.

METHODS

Data were obtained from the China National Stroke Screening Survey. From January 2016 to December 2023, a total of 15,471 permanent residents aged ≥40 years in Yinchuan were screened. Patients with nonvalvular atrial fibrillation who had their first stroke were selected as the stroke group (86 patients), and patients with nonvalvular atrial fibrillation who had never had a stroke as the control group (477 patients).

RESULTS

In 563 residents, the crude prevalence of SIPWNVAF was 15.28%, and the standardized prevalence was 9.33%. The multivariable logistic regression analysis revealed that age (odds ratio [OR]: 1.42; 95% confidence interval [CI]: 1.17-1.71), smoking (OR: 2.10; 95% CI: 1.46-3.01), drinking (OR: 2.00; 95% CI: 1.28-3.13), lack of exercise (OR: 2.18; 95% CI: 1.18-4.03), family history of stroke (OR: 4.39; 95% CI: 1.82-10.57), hypertension (OR: 1.94; 95% CI: 1.03-3.63), diabetes (OR: 3.10; 95% CI: 1.37-7.05), dyslipidemia (OR: 2.15; 95% CI: 1.16-3.99), homocysteine ≥15 μmol/L (OR: 2.13; 95% CI: 1.14-3.97), and carotid atherosclerosis (OR: 2.86; 95% CI: 1.53-5.37) were independent risk factors, but educational level (OR: 0.31; 95% CI: 0.17-0.58) was a protective factor for SIPWNVAF.

CONCLUSIONS

The stroke group is significantly more burdened by other independent common risk factors for stroke.

Neurological Consequences of Cardiac Arrhythmias: Relationship Between Stroke, Cognitive Decline, and Heart Rhythm Disorders

Cardiac arrhythmias are one of the most common disorders with high morbidity and mortality. The effect of cardiac arrhythmias on the brain is very pronounced due to the high sensitivity of the brain to oxygen and blood supply. This mortality is preventable by early diagnosis and treatment which improves the patient's quality of life. Intervening at the right time, post arrhythmia is significant in preventing deaths and improving patient outcomes. Multiple pathophysiological mechanisms are studied for the brain-axis implications, that have the potential to be targeted by novel therapies. In this review, we describe the pathophysiological mechanisms and recent advances in detail to understand the functional aspects of the brain-heart axis and neurological implications post-stroke, caused by cardiac disorders.  This paper aims to discuss the current literature on the neurological consequences of cardiac arrhythmias and delve into a deeper understanding of the brain-heart axis, imbalances, and decline, with the aim of summarizing everything and all about the neurological consequences of cardiac arrhythmias.

Impact of Anticoagulants in Reducing Mortality and Disability in Cardioembolic Stroke Patients

Background and Objectives: Stroke is currently the second most common cause of death and disability-adjusted life years worldwide. Previous studies have determined that cardioembolic stroke is associated with higher mortality. Our aim is to compare the long-term outcome and mortality of atherothrombotic, cardioembolic stroke patients and patients taking direct oral anticoagulants (DOACs), and to demonstrate that adequate treatment with DOACs is associated with better results. Materials and Methods: In our retrospective study, we collected the data of ischemic stroke patients who were treated at P. Stradins Clinical University Hospital, Riga, Latvia, Stroke Unit, in the year 2017. In the present study, we analyzed this information to assess the patients’ demographic and clinical data, vascular risk factors, functional and neurological evaluation results, and the use of anticoagulant therapy. Stroke survivors were followed-up via telephone at 30/90/180/365 days and 4 years after being discharged from the hospital. The Latvian version of the National Institutes of Health Stroke Scale (NIHSS-LV) was used to evaluate patients’ neurological outcomes at discharge, and patients’ functional outcomes were evaluated using the modified Rankin scale (mRS). The collected data of the patients were separated into three groups according to the stroke subtype and use of direct oral anticoagulants. Results: A total of 654 ischemic stroke patients were admitted to the hospital in the year 2017. Of all the strokes included in the study, 262 presented an atherothrombotic etiology and 392 presented a cardioembolic etiology. The median age of the patients in the study was 76 years (IQR: 67–83). The median age of patients in the atherothrombotic stroke group was 71 years (IQR = 64–79), in the cardioembolic stroke group it was 79 (IQR = 72–84), and in the DOAC group it was 75 years (IQR = 69–82), respectively. At the period of four years, of all the atherothrombotic stroke survivors 14 (10.5%) had a severe disability, and 64 (48.1%) did not survive. However, 12 (4.1%) of the cardioembolic stroke survivors were severely disabled and 37 (12.5%) had died. In the group of patients taking DOACs 6 (4.5%) had a severe disability and 17 (12.9%) did not survive. In all the patient groups, the leading cause of death was due to severe disability (22%), followed by recurrent cardioembolic events (8%). Conclusions: Previous studies until now have concluded that cardioembolic stroke is associated with higher mortality and an unfavorable functional outcome. In our study, the cardioembolic stroke group and the DOAC group had a statistically significant higher percentage of patients with congestive heart failure and older age, but their long-term mortality was lower and they achieved independence more often than the atherothrombotic stroke patients. The proper use of anticoagulants shows great improvement in long-term survival rate and functional outcome.