ESOC 2025 | The risk of recurrent stroke in patients with AF detected before or after stroke
Michele Romoli, MD, PhD, Bufalini Hospital, Cesena, Italy, discusses a meta-analysis investigating the risk of recurrent ischemic stroke, intracranial hemorrhage, and mortality in patients with atrial fibrillation (AF) detected before or after stroke. The analysis found that the risk of ischemic stroke recurrence was significantly lower in the group with AF detected after stroke, suggesting that this subgroup may carry a lower risk of ischemic stroke recurrence and mortality compared to those with known AF. This interview took place at the 11th European Stroke Organisation Conference (ESOC) in Helsinki, Finland.
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Transcript
Regarding atrial fibrillation and the risk of recurrent stroke and mortality, overall the risk of recurrent ischemic stroke, the intracranial hemorrhage and mortality in people with atrial fibrillation detected after stroke is still unclear compared to people with known atrial fibrillation. So what we did is a systematic review and meta-analysis of studies that investigated the difference between these two types of atrial fibrillation, the one detected after stroke and the one known at the time of stroke...
Regarding atrial fibrillation and the risk of recurrent stroke and mortality, overall the risk of recurrent ischemic stroke, the intracranial hemorrhage and mortality in people with atrial fibrillation detected after stroke is still unclear compared to people with known atrial fibrillation. So what we did is a systematic review and meta-analysis of studies that investigated the difference between these two types of atrial fibrillation, the one detected after stroke and the one known at the time of stroke. So overall we included studies published up to 2024 and we had a systematic procedure so we included cohort observational studies and randomized control trials and excluded studies with less than 15 patients per group. We assessed eligible studies for bias using the ROBINS-I2 and we pooled study-level results through random effect meta-analysis of risk ratio. Overall, we included 17 studies with more than 113,000 patients and 49% female. And interestingly, eight of these 17 studies had low risk of bias, so this gives some robustness to our estimates. The ischemic stroke recurrence was significantly lower in the atrial fibrillation group detected after stroke, so AFDAS, compared to the non-atrial fibrillation group. And this was significantly lower with a risk ratio of 0.79. The meta regression analysis revealed no specific interaction of anticoagulation, CHA2DS2-VASc score, or sex on the difference in risk of recurring ischemic stroke between groups. This means that this difference seems to be very much consistent on the grouping, so on the AFDAS group and CAF group. This means that AFDAS overall may carry a lower risk of the ischemic stroke recurrence and mortality compared to known atrial fibrillation with similar risk of intracerebral hemorrhage. So, stratification through implementation of atrial fibrillation burden measure may support more personalized management for people with atrial fibrillation detected after stroke.
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