ESOC 2025 | The Cardiac Assessment for Recurrent Stroke Risk Evaluation in Atrial Fibrillation (CARE-AF) trial

I was really excited to present my study CARE-AF today at the ESOC Young Stroke Research and Physicians Study Design Workshop. It’s a prospective cohort study on patients with atrial fibrillation and acute stroke and we’re trying to find out mechanisms in patients with breakthrough strokes, so patients who are on anticoagulant therapy at the time of their index strokes compared to those who are OAC naïve. And the idea from the study derives from an unmet clinical need or an unmet clinical question that patients with atrial fibrillation and anticoagulant therapy at time of their stroke, they suffer from a very high risk of recurrent stroke of up to seven to nine percent per year. And that’s much higher actually than the reported risk of stroke in patients who were not under anticoagulant therapy. And we found it frustrating that when patients and families are asking us at the round on the stroke unit on why they suffered a stroke despite taking the medication, we don’t have an answer to that. And for our study, we’re collecting clinical data. So for example, the usual cerebrovascular risk factors, but also data on atrial fibrillation burden after the stroke with additional Holter ECG. We’re collecting serum cardiac biomarkers such as NT-proBNP, troponin and D-dimers, and also MR-proANP, which is a very good marker of atrial cardiomyopathy. And lastly, we’ll perform echocardiography in all patients. And if patients got a TTE, we’ll measure left atrial enlargement and also left atrial strain. So sort of the function of the left atrium. And if they get a TOE, we’ll assess left atrial appendage morphology and volume. And also left atrial appendage flow velocity. Because all these parameters have been associated with stroke, but not in such a high-risk cohort as in ours. And then we try to find out some mechanisms to find an answer to our patients’ questions.

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