New-Onset as Opposed to Established Atrial Fibrillation as a Risk Factor for Incident Stroke

Authors

Hassan Aboul-Nour, Departments of Neurology and Neurosurgery, University of Kentucky, Lexington, KY, USA; Department of Neurology, Henry Ford Hospital, Detroit, MI, USA. Electronic address: aboulnourh@gmail.com.
Ammar Jumah, Department of Neurology, Henry Ford Hospital, Detroit, MI, USA.
Lonni Schultz, Department of Neurology, Henry Ford Hospital, Detroit, MI, USA.
Muhammad Affan, Department of Neurology, University of Minnesota, Minneapolis, MN, USA.
Karam Gagi, Department of Neurology, Michigan State University, Lansing, MI, USA.
Omar Choudhury, Department of Neurology, Henry Ford Hospital, Detroit, MI, USA.
Megan Brady, Department of Neurology, Henry Ford Hospital, Detroit, MI, USA.
Dawn Scozzari, Department of Neurology, Henry Ford Hospital, Detroit, MI, USA.
Fadi Nahab, Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
Daniel J. Miller, Department of Neurology, Henry Ford Hospital, Detroit, MI, USA.
Stephan A. Mayer, Departments of Neurology and Neurosurgery, New York Medical College, Valhalla, NY, USA.

Author Type(s)

Faculty

Journal Title

Clinical Neurology and Neurosurgery

First Page

108106

Document Type

Article

Publication Date

1-1-2024

Department

Neurology

Abstract

BACKGROUND: Atrial fibrillation (AF) is an established risk factor for acute ischemic stroke (AIS). It remains unclear if new-onset AF confers a higher risk of AIS than longer-standing AF. METHODS: We retrospectively analyzed all stroke-free patients who underwent transthoracic echocardiography (TTE) in the Henry Ford Health System between March 6 and September 6, 2016. Incident AIS and new-onset AF were ascertained by the presence of new diagnostic codes in the electronic medical record over a follow-up period of up to 5 years. Cox proportional hazards regression was used to identify risk factors for new-onset AF or AIS. RESULTS: Of 7310 patients who underwent baseline TTE the mean age was 65 years, 54% were female, 51% were Caucasian, and 46% had left atrial enlargement (LAE). Of at-risk patients, 10.9% developed new-onset AF and 2.9% experienced incident AIS. The risk of new-onset AF among at-risk patients was 3.1 times higher among patients with any degree of LAE compared to those with normal LA size (95% CI 2.6-3.6, P < 0.0001). New-onset AF, more than established AF, in turn had a powerful association with incident AIS. The cumulative 5-year risk of AIS was 3.5% in those without AF, 5.9% in those with established AF prior to TTE, and 20.1% in those with new-onset AF (P < 0.0001). In multivariable analysis new-onset AF had the strongest association with incident AIS (P < 0.0001), followed by increasing age (P = 0.0025), black race (P = 0.0032), and smoking (P = 0.0063). CONCLUSIONS: New-onset AF has a strong relationship with incident AIS. LAE was present in nearly half of stroke-free patients undergoing TTE, and was associated with a significantly higher likelihood of new-onset AF during follow-up. Vigilant cardiac monitoring for AF in individuals with LAE, coupled with the timely initiation of anticoagulation, may be an important strategy for the primary prevention of AF-related stroke.

Recommended Citation

Aboul-Nour, H., Jumah, A., Schultz, L., Affan, M., Gagi, K., Choudhury, O., Brady, M., Scozzari, D., Nahab, F., Miller, D. J., & Mayer, S. A. (2024). New-Onset as Opposed to Established Atrial Fibrillation as a Risk Factor for Incident Stroke. Clinical Neurology and Neurosurgery, 236, 108106. https://doi.org/10.1016/j.clineuro.2023.108106