Incidence of cardioembolic stroke related to atrial fibrillation in Joinville, Brazil

Diegolli, Henrique; Silva, Gustavo Figueiredo da; Lacerda, Marcelo Pitombeira de; Oliveira, Raddib Eduardo Noleto da Nobrega; Souza, Felipe Fanine de; Silva, Caroline Figueiredo da; Machado, Felipe Reinert Avilla

doi:10.1055/S-0043-1767821

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Original Article • Arq. Neuropsiquiatr. 81 (4) • Apr 2023 • https://doi.org/10.1055/S-0043-1767821 copy

Incidence of cardioembolic stroke related to atrial fibrillation in Joinville, Brazil

Incidência de acidente vascular encefálico relacionado à fibrilaçao atrial em Joinville, Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Atrial fibrillation (AF) is an important cause of cardioembolic stroke, and population aging has increased its prevalence.

Objective

To evaluate the incidence of cardioembolic stroke caused by AF in the city of Joinville, Brazil, as well as previous diagnoses and use of medication.

Methods

Between 2017 and 2020 we extracted data from the population-based Joinville Stroke Registry. Demographic characteristics, diagnosis of AF, and patterns of medication use were collected, and the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) system was used to classify the etiology.

Results

There were 3,303 cases of ischemic stroke, 593 of which were cardioembolic, and 360 had AF. Of the patients with AF, 258 (71.6%) had a previous diagnosis of the disease, and 102 (28.3%) were newly diagnosed after the stroke. Among patients with a previously-diagnosed AF, 170 (47.2%) were using anticoagulants, and 88 (24.4%) were using other medications.

Conclusion

During the analyzed period, ischemic stroke caused by AF was a significant burden on the population of Joinville, and a considerable number of patients had undiagnosed or untreated AF.

Keywords:
Atrial Fibrillation; Ischemic Stroke; Embolic Stroke; Cohort Studies

Year	Ischemic stroke		Cardioembolic stroke		Proportion of ischemic strokes (95% confidence interval)
Year	n	Cases per 100 thousand inhabitants	n	Cases per 100 thousand inhabitants	Proportion of ischemic strokes (95% confidence interval)
2017	838	145.6	164	28.5	19.6% (16.9%–22.3%)
2018	800	137.2	147	25.2	18.4% (15.7%–21.1%)
2019	839	142.1	142	24.0	16.9% (14.4%–19.5%)
2020	826	138.2	140	23.4	16.9% (14.4%–19.5%)
Total	3,303	140.7	593	25.3	18.0% (16.6%–19.3%)

		N	Proportion (95% confidence interval)
Previous diagnosis of atrial fibrillation	Newly-diagnosed atrial fibrillation	94	26.1% (21.6%–30.6%)
	Previously-known atrial fibrillation	222	61.7% (56.6%–66.7%)
	Previously-known paroxysmal atrial fibrillation	36	10.0% (6.9%–13.1%)
	Newly-diagnosed paroxysmal atrial fibrillation	8	2.2% (0.7%–3.7%)
Age in years of the patients with atrial fibrillation	0–39	2	0.6% (0.0%–1.3%)
	40–49	5	1.4% (0.2%–2.6%)
	50–59	28	7.8% (5.0%–10.5%)
	60–69	78	21.7% (17.4%–25.9%)
	70–79	114	31.7% (26.9%–36.5%)
	80–89	115	31.9% (27.1%–36.8%)
	≥ 90	18	5.0% (2.7%–7.3%)

		N	Proportion (95% confidence interval)
Type of previous medication use among patients with atrial fibrillation	Anticoagulants	170	47.2% (42.1%–52.4%)
	Other medication	88	24.4% (20.0%–28.9%)
Anticoagulant used (among patients with reported use)	Warfarin	61	35.9% (28.7%–43.1%)
	Direct oral anticoagulants	59	34.7% (27.5%–41.9%)
	Not registered	50	29.4% (22.6%–36.3%)
Patterns of previous use of medication	Takes the medication regularly	146	79.3% (73.5%–85.2%)
	Takes the medication irregularly	21	11.4% (6.8%–16.0%)
	Stopped using the medication	17	9.2% (5.1%–13.4%)

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[1] Address for correspondence Gustavo Figueiredo da Silva (email: gustavofigsilva@outlook.com).