Outcome, Recurrence and Mortality after Non-Valvular Atrial Fibrillation Stroke: Long-Term Follow-Up Study

Abstract

Objective—Non-valvular atrial fibrillation (NVAF) is a major risk factor for ischemic stroke (IS) and a
powerful predictor of mortality. This study investigates early and long-term outcome among patients with
IS secondary to NVAF and identify the main factors associated with poor outcome, recurrence, and death.
Methods—We analyzed the data from our consecutive NVAF acute IS database, over a period of 23 years.
The endpoints were bad outcome (Modified Rankin Score ≥3), recurrence, and mortality at discharge, after
6 months, 12 months, and final follow-up. Multivariate Cox and Kaplan–Meier analysis were used to estimate the probability of death.
Results—129 consecutive acute IS patients were included (77 [59.7%] females, mean age 70.2 ± 10.1
years). Discharge, 6 and 12 months bad outcome was 62%, 63%, and 61%, respectively. After a median
follow-up of 17 months (IQR 6–54.5), 35.6% patients had bad outcome, 21.7% had recurrence and 36.4%
died. The recurrence and death annual rates were 19.1% and 6.32%. The absence of oral anticoagulation
(OAC) and NIHSS score > 12 were the strongest predictors of mortality.
Conclusions—IS secondary to NVAF has a high rate of stroke recurrence and mortality in our population, with the absence of OAC and major stroke as the main risk factors.