BMJ Open (Jul 2019)
Potential missed opportunities to prevent ischaemic stroke: prospective multicentre cohort study of atrial fibrillation-associated ischaemic stroke and TIA
- ,
- Gregory Y H Lip,
- Michael Power,
- Martin M Brown,
- Matthew Smith,
- Christopher Price,
- Tarek Yousry,
- Gargi Banerjee,
- David J Werring,
- Gareth Ambler,
- Michelle Davis,
- Chris Patterson,
- Keith Muir,
- Krishna Dani,
- Julie Staals,
- Jon Scott,
- Pankaj Sharma,
- Duncan Wilson,
- Clare Shakeshaft,
- Hannah Cohen,
- Kirsty Harkness,
- Louise Shaw,
- Jane Sword,
- Roland Veltkamp,
- Deborah Kelly,
- Frances Harrington,
- Marc Randall,
- Karim Mahawish,
- Abduelbaset Elmarim,
- Bernard Esisi,
- Claire Cullen,
- Arumug Nallasivam,
- Adrian Barry,
- Christine Roffe,
- John Coyle,
- Ahamad Hassan,
- Caroline Lovelock,
- Jonathan Birns,
- David Cohen,
- L Sekaran,
- Adrian Parry-Jones,
- Anthea Parry,
- David Hargroves,
- Harald Proschel,
- Prabel Datta,
- Khaled Darawil,
- Aravindakshan Manoj,
- Mathew Burn,
- Elio GialloMbardo,
- Nigel Smyth,
- Syed Mansoor,
- Ijaz Anwar,
- Rachel Marsh,
- Sissi Ispoglou,
- Dinesh Chadha,
- Mathuri Prabhakaran,
- Sanjeevikumar Meenakishundaram,
- Vinodh Krishnamurthy,
- Prasanna Aghoram,
- Michael McCormick,
- Nikola Sprigg Paul O’Mahony,
- Peter Wilkinson,
- Simon Leach,
- Sarah Caine,
- Ilse Burger,
- Gunaratam Gunathilagan,
- Paul Guyler,
- Hedley Emsley,
- Dulka Manawadu,
- Kath Pasco,
- Maam Mamun,
- Robert Luder,
- Mahmud Sajid,
- James Okwera,
- Elizabeth Warburton,
- Kari Saastamoinen,
- Timothy England,
- Janet Putterill,
- Enrico Flossman,
- David Mangion,
- Appu Suman,
- John Corrigan,
- Enas Lawrence,
- Djamil Vahidassr,
- Janice O’Connell,
- Mark White,
- Martin Cooper,
- Lillian Choy,
- David Seiffge,
- Andreas Charidimou,
- H R Jäger,
- Azlisham Mohd Nor,
- Al-Shahi Salman Rustam
Affiliations
- Gregory Y H Lip
- 4 Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
- Michael Power
- medical practitioner
- Martin M Brown
- 11 Neurology, UCL, London, UK
- Matthew Smith
- Department of Obstetrics & Gynaecology, Royal Brisbane and Women`s Hospital, Brisbane, Queensland, Australia
- Christopher Price
- Population Health Sciences Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
- Tarek Yousry
- Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, UK
- Gargi Banerjee
- 2 Brain Repair and Rehabilitation, Institute of Neurology, UCL, London, UK
- David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Gareth Ambler
- 6 Department of Statistical Science, University College London, London, UK
- Michelle Davis
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
- Chris Patterson
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- Keith Muir
- Neurology, University of Glasgow, Glasgow, UK
- Krishna Dani
- Neurology, Institute of Neurological Sciences, Glasgow, UK
- Julie Staals
- Jon Scott
- 1 School of Medical Education, Newcastle University, Newcastle Upon Tyne, UK
- Pankaj Sharma
- 4 Neurology, LSU Health Shreveport, Shreveport, Louisiana, USA
- Duncan Wilson
- New Zealand Brain Research Institute, Christchurch, New Zealand
- Clare Shakeshaft
- 2 Brain Repair and Rehabilitation, Institute of Neurology, UCL, London, UK
- Hannah Cohen
- 19 Department of Haematology, University College London, London, UK
- Kirsty Harkness
- Louise Shaw
- Faculty of Health Science, Youth & Community Studies, Holmesglen Institute of TAFE, Parkdale, Victoria, Australia
- Jane Sword
- consultant elderly care physician
- Roland Veltkamp
- Deborah Kelly
- Frances Harrington
- Marc Randall
- Department of Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Karim Mahawish
- Department of Internal Medicine, Palmerston North Hospital, Palmerston North, New Zealand
- Abduelbaset Elmarim
- Bernard Esisi
- Claire Cullen
- Arumug Nallasivam
- Adrian Barry
- Christine Roffe
- Neurosciences, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
- John Coyle
- Ahamad Hassan
- 11 Department of Neurology, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Caroline Lovelock
- Jonathan Birns
- 3 Department of Ageing & Health, Guy`s and St Thomas` NHS Foundation Trust, London, UK
- David Cohen
- Department of Child and Adolescent Psychiatry, Hôpital Pitié–Salpétrière, Institut des Systèmes Intelligents et Robotiques, Université Pierre et Marie Curie, Paris, France
- L Sekaran
- Adrian Parry-Jones
- 1The University of Manchester, Manchester, UK
- Anthea Parry
- David Hargroves
- Stroke Medicine, Kent and Canterbury Hospital, Canterbury, UK
- Harald Proschel
- Prabel Datta
- Khaled Darawil
- Aravindakshan Manoj
- Mathew Burn
- Elio GialloMbardo
- Nigel Smyth
- Syed Mansoor
- Ijaz Anwar
- Rachel Marsh
- Sissi Ispoglou
- Dinesh Chadha
- Mathuri Prabhakaran
- Sanjeevikumar Meenakishundaram
- Vinodh Krishnamurthy
- Prasanna Aghoram
- Michael McCormick
- Nikola Sprigg Paul O’Mahony
- Peter Wilkinson
- Simon Leach
- Sarah Caine
- Registrar
- Ilse Burger
- Gunaratam Gunathilagan
- Paul Guyler
- Hedley Emsley
- consultant neurologist and honorary lecturer
- Dulka Manawadu
- 1Department of Stroke Medicine, Division of Trauma and Emergency Medicine, Kings College Hospital, London, UK
- Kath Pasco
- Maam Mamun
- Robert Luder
- Mahmud Sajid
- James Okwera
- Elizabeth Warburton
- 1Department of Medicine, University of Cambridge
- Kari Saastamoinen
- Timothy England
- Janet Putterill
- Enrico Flossman
- David Mangion
- Appu Suman
- John Corrigan
- 3 Occupational Health Service, Belfast Health and Social Care Trust, Belfast, UK
- Enas Lawrence
- Djamil Vahidassr
- Janice O’Connell
- 3 School of Medical Education, Newcastle University, Newcastle Upon Tyne, UK
- Mark White
- 2 Cancer Research UK, Beatson Institute for Cancer Research, Glasgow, UK
- Martin Cooper
- Lillian Choy
- David Seiffge
- 1 Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Andreas Charidimou
- 4 Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
- H R Jäger
- 4 Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
- Azlisham Mohd Nor
- Al-Shahi Salman Rustam
- 1Department of Clinical Neuroscience, Royal Infirmary of Edinburgh
- DOI
- https://doi.org/10.1136/bmjopen-2018-028387
- Journal volume & issue
-
Vol. 9,
no. 7
Abstract
Objective We report on: (1) the proportion of patients with known atrial fibrillation (AF); and (2) demographic, clinical or radiological differences between patients with known AF (and not treated) and patients with newly diagnosed AF, in a cohort of patients who presented with ischaemic stroke or transient ischaemic attack (TIA) not previously treated with anticoagulation.Design We reviewed cross-sectional baseline demographic and clinical data from a prospective observational cohort study, (CROMIS-2).Setting Patients were recruited from 79 hospital stroke centres throughout the UK and one centre in the Netherlands.Participants Patients were eligible if they were adults who presented with ischaemic stroke or TIA and AF and had not been previously treated with oral anticoagulation.Main outcome measures Proportion of patients with known AF before index ischaemic stroke or TIA from a cohort of patients who have not been previously treated with oral anticoagulation. Secondary analysis includes the comparison of CHA2DS2-VASc and HAS-BLED scores and other demographics and risk factors between those with newly diagnosed AF and those with previously known AF.Results Of 1470 patients included in the analysis (mean age 76 years (SD 10)), 622 (42%) were female; 999 (68%) patients had newly diagnosed AF and 471 (32%) patients had known AF. Of the 471 patients with known AF, 68% had a strong indication for anticoagulation and 89% should have been considered for anticoagulation based upon CHA2DS2-VASc score. Patients with known AF were more likely to have a prior history of dementia (4% vs 2%, p=0.02) and had higher HAS-BLED scores (median 3 vs 2). CHA2DS2-VASc, other risk factors and demographics were similar.Conclusions About 1/3 of patients who present with stroke and have AF who have not been treated with oral anticoagulation have previously known AF. Of these patients, at least 68% were not adequately treated with oral anticoagulation.Trial registration number NCT02513316.