Impact of atrial fibrillation/flutter on the in-hospital mortality of ischemic stroke patients

BACKGROUND Stroke is the second leading cause of death worldwide. Ischemic strokes, which are caused by atrial fibrillation/flutter (AF), may be more devastating than those that occur without AF. OBJECTIVE The purpose of this study was to investigate the impact of AF on adverse events in hospitalized ischemic stroke patients and to estimate the elevated impact of AF on the occurrence of these adverse events. METHODS The nationwide German inpatient sample of the years 2005-2015 was used for this analysis. Ischemic stroke patients were identified by ICD code I63 and stratified by AF. Logistic regression models were used to investigate the impact of AF on adverse in-hospital events and adjusted for age, sex, and comorbidities to prove the independence of the associations. RESULTS Overall, 2,958,697 hospitalized ischemic stroke patients (50.5% female, 65.4% age >70 years) were included in the analysis. Of these patients, 849,466 (28.7%) were diagnosed with AF. Overall, 9.0% of the stroke patients died in-hospital. The case fatality rate increased with age and was higher in stroke patients with AF than in those without AF (13.0% vs 7.3%; P < .001). AF was an important predictor of in-hospital death (odds ratio 1.30; 95% confidence interval 1.28-1.31; P < .001) and adverse events during hospitalization, independent of age, sex, and comorbidities. Deterioration of patient prognosis due to AF was especially pronounced in younger patients. CONCLUSION AF in ischemic stroke patients is associated with higher in-hospital mortality and higher rate of adverse events during hospitalization, independent of age, sex, and comorbidities.