Differences in in-hospital clinical course, management and outcome between stroke with and without atrial fibrillation. A retrospective analysis from the SETI (Studio Epidemiologico Toscano Ictus) study

BACKGROUND Stroke in patients with Atrial Fibrillation (AF) differs from Not Atrial Fibrillation Strokes (NAFS) in severity of onset and outcome but other variables may worsen the clinical scenario.
MATERIALS AND METHODS We studied 738 patients (430 females and 308 males), with mean age 78.7 ± 9.9 years (female 81.0 ± 8.9; male 75.2 ± 10.2; p < 0.001) consecutively admitted for stroke to the Internal Medicine Departments of Tuscany in a three months period (March 1 to May 31, 2003) in order to ascertain if the in-hospital burden of Atrial Fibrillation Strokes (AFS) was different from that of NAFS. Demographic data, clinical conditions before admission, the mode and timing of hospital admission, clinical presentation, treatment, complications, and outcome and the mode of discharge were examined.
RESULTS AFS were 205 (27.8%) and NAFS 533 (72.2%). Mean age of AFS was significantly higher (p < 0.001). Heart failure, ischemic heart disease, dilatative cardiomyopaties and chronic renal insufficiency were more prevalent in the AFS. The clinical presentation with a lower (3-6) Glasgow Coma Scale (GCS) score (p < 0.01) prevailed in AFS patients. The in-hospital therapy showed a greater use of antiplatelet agents in the NAFS (97.1% vs 63%, p < 0.001) and oral anticoagulants in AFS (11% vs 1.3%, p < 0,001). AFS patients showed much complications, higher degree of disability at discharge and mortality (47 AFS = 23% vs 67 NAFS = 12.8%, p < 0.001). Multivariate analysis confirms that AFS is more serious than NAFS owing to pathogenetic mechanisms: this results in a higher number of complications, a longer hospitalisation and a worse prognosis in terms of survival and disability. This dycothomy begins early as the symptoms start.