Neurology care and the long-term outcomes of atrial fibrillation-related ischaemic stroke in China: median 3-year outcome from a high volume academic tertiary hospital

Abstract

Objectives The initial medical contact of patients with atrial fibrillation (AF) and ischaemic stroke is often performed by neurologists. However, when stand care with oral anticoagulants (OACs) adherence and persistence was emphasised by cardiologists, data regarding the gap between current neurology care and standard care from Chinese tertiary hospitals is scarce and the long-term outcome is unknown. This study was to investigate the AF detection rate, the use of anticoagulation therapy and posthospital clinical outcomes associated with neurology care in patients with AF and ischaemic stroke in China.Design A retrospective cohort study.Setting Clinical data of all patients who had an ischaemic stroke discharged from the neurologic department of a high-volume academic hospital from 1 January 2013 to 31 December 2017 were analysed and patients were followed.Participants Patients diagnosed with ischaemic stroke and AF were included.Main outcome measures The usage of anticoagulation at discharge, the posthospital restroke rate and all-cause mortality.Results Among 5797 patients who had an ischaemic stroke, 373 (6.43%) patients were diagnosed with AF during hospitalisation. Among them, only 198 (53.66%) patients were on anticoagulation therapy at discharge. A total of 325 (88.08%) patients were accessible and received follow-up. After a median 3-year follow-up, 103 (31.69%) patients died due to all causes. Among them, 53 (16.31%) patients died from recurrent stroke. And 86 (26.46%) patients restroked. In multivariable analysis, patients without anticoagulation therapy, muscle strength<grade 3 at discharge, coronary artery disease and advanced age predicted the recurrent stroke.Conclusions Secondary stroke prevention in AF patients associated with neurology care is challenging in China, as manifested by a lower AF detection rate, significant underuse of OACs, high mortality and recurrent stroke rate. Efforts to increasing the AF detection rate and reinforce education on neurologists should be made to improve neurology care and intensify posthospital management in such patients.