Atrial Fibrillation In Patients With Stroke Attributed to Large- or Small-Vessel Disease
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Published:2023-12-01
Issue:12
Volume:80
Page:1277
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ISSN:2168-6149
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Container-title:JAMA Neurology
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language:en
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Short-container-title:JAMA Neurol
Author:
Bernstein Richard A.1, Kamel Hooman23, Granger Christopher B.4, Piccini Jonathan P.4, Katz Jeffrey M.5, Sethi Pramod P.6, Pouliot Erika7, Franco Noreli7, Ziegler Paul D.8, Schwamm Lee H.9, Acosta Indrani10, Jamnadas Pradipkumar10, Manda Sushma10, Alimohammad Rizwan10, Arias Valerie10, Tempro Kristi10, Ward Kathleen10, Asi Khaled10, Choudhuri Indrajit10, Guerrero Waldo10, Kalia Junaid10, Niazi Imran10, Sajjad Rehan10, Thavapalan Varoon10, Assar Manish10, Banchs Javier10, Black James10, Cheung Peter10, Donsky Alan10, Graybeal Dion10, Hasan Rashedul10, Mir Osman10, Nguyen Claude10, Olsovsky Gregory10, Rasmussen Jennifer10, Hasabnis Sanjeev10, Reeves Russell10, Rowley Chris10, Sharma Jitendra10, Smith Macey10, Bonyak Kay10, Sackett Matthew10, Allred James10, Sethi Pramod10, Jung Richard10, Lynch Jennifer10, Rowe Steven10, Dash Subasini10, Glotzer Taya10, Jamal Sameer10, Radoslovich Glauco10, Shukla Gunjan10, Zimmerman John10, Hussein Haitham10, Zhu Dennis10, Krueger Kristopher10, Ostrander Matthew10, Ramirez Darwin10, Shultz Jeffrey10, Simonson Jay10, Cucchiara Brett10, Deo Rajat10, Frankel David10, Jia Judy10, Kasner Scott10, Luciano Jeanie10, Messe Steven10, Mullen Michael10, Santangeli Pasquale10, Schaller Robert10, Yuan Qingyang10, Bledsoe Don10, Cajavilca Christian10, Chiu David10, Gadhia Rajan10, Grimes Maranda Randi10, Katz Larry10, Moye Stacy10, Rami Tapan10, Thomas Abraham10, Volpi John10, Al Balushi Ali10, Boyd Clara10, Choudry Subbarao10, Dhamoon Mandip10, Dukkipati Srinivas10, Goltz Davida10, Hao Qing10, Horowitz Deborah10, Kaur Gurmeen10, Koruth Jacob10, Kurian Christeena10, Langan Marie-Noelle10, Matos Diaz Ivan10, Miller Marc10, Reddy Vivek10, Sheinart Kara10, Stein Laura10, Tansy Aaron10, Tuhrim Stanley10, Weinberger Jesse10, Whang William10, Cross Jonathan10, Kreger Howard10, Saltzman Marc10, Zide Kenneth10, Bansal Sandeep10, Bernabei Matthew10, Flaster Murray10, Barrett Conor10, Etherton Mark10, Heist E. Kevin10, Lubitz Steven10, Regenhardt Robert10, Sharma Richa10, Silverman Scott10, Sloane Kelly10, Viswanathan Anand10, Doshi Amit10, Logan William10, Malik Maheen10, Rempe David10, Arora Rohan10, Beldner Stuart10, Epstein Laurence10, Ismail Haisam10, Jadonath Ram10, Katz Jeffrey10, Libman Richard10, Moussavi Mohammad10, Patel Anand10, Patel Apoor10, Willner Jonathan10, Wright Paul10, Caprio Frances10, Kim Susan10, Mendelson Scott10, Passman Rod10, Ruff Ilana10, Alsorogi Mohammad10, Chaudhary Gauhar10, Morris Kent10, Mullins Savannah10, Talpur Nadeem10, Thomas Kevin10, Chancellor Breehan10, Chinitz Larry10, Culpepper Andre10, Fara Michael10, Ishida Koto10, Lillemoe Kaitlyn10, Lord Aaron10, Torres Jose10, Zhang Cen10, Abi-Samra Freddy10, Bernard Michael10, Carter Jacqueline10, Chokhawala Himanshu10, Downey Amanda10, Khatib Samuel10, Morin Daniel10, Polin Glenn10, Rogers Paul10, Vidal Gabriel10, Zweifler Richard10, Belt Gary10, Felberg Robert10, Furer Steve10, Hanna John10, McCall-Brown Angela10, Seeger Susan10, Reddy Ramakota10, Skalabrin Elaine10, Soik Diane10, Wilder Michael10, Kearney Michelle10, LaFranchise Eugene10, Parker Brett10, Pickett Robert Andrew (Drew)10, Bonaguidi Heather10, Gibson Douglas10, Kalafut Mary10, Mattera Beth10, Olson Nicholas10, Parker Mary10, Rogers John10, Uddin Poulina10, Chang Cherylee10, Graner Sarah10, Kipta Joseph10, Salem Rony10, Singh David10, Al-Awwad Ahmad10, Beaver Bahar10, Chaudhary Shuchi10, Clayton Stephen10, Delpirou Nouh Claire10, Garabelli Paul10, Gordon David10, Pakala Aneesh10, Ray Bappaditya10, Saucedo Scott10, Sidorov Evgeny10, Stavrakis Stavros10, Ching Marilou10, Deline Christopher10, Hourihane J. Maurice10, Kandel Amit10, Kim Chee10, Magun Rakesh10, Mowla Ashkan10, Sawyer Robert10, Switzer Donald10, Badhwar Nitish10, Lee Randall10, Meisel Karl10, Smith Wade10, Alkahalifah Moayd10, Aroor Sushanth10, Asdaghi Negar10, Bhatt Nirav10, Del Brutto Victor10, Dillon George10, Gadient Paul10, Koch Sebastian10, Lambrakos Litsa10, Malik Amer10, Marulanda-Londono Erika10, Memon Zeeshan10, Mendoza Ivan10, Mitrani Raul10, Ortiz Gustavo10, Ramano Jose10, Sur Nicole10, Torres Luis10, Daniels James10, Johnson Mark10, Magadan Alejandro10, Shang Ty10, Mcclelland Nancy10, Merriam Theodore10, Neisen Karah10,
Affiliation:
1. Davee Department of Neurology, Feinberg School of Medicine of Northwestern University, Chicago, Illinois 2. Department of Neurology, Weill Cornell Medicine, New York, New York 3. Deputy Editor, JAMA Neurology 4. Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina 5. Department of Neurology and Radiology, North Shore University Hospital, Manhasset, New York 6. Guilford Neurology Associates, Moses H. Cone Hospital, Greensboro, North Carolina 7. Cardiac Rhythm Management, Clinical Department, Medtronic, Minneapolis, Minnesota 8. Cardiac Rhythm Management, Research Department, Medtronic, Minneapolis, Minnesota 9. Department of Digital Strategy and Transformation, Yale School of Medicine, New Haven, Connecticut 10. for the STROKE AF Investigators
Abstract
ImportanceThe STROKE AF study found that in patients with prior ischemic stroke attributed to large-artery atherosclerotic disease (LAD) or small-vessel occlusive disease (SVD), 12% developed AF over 1 year when monitored with an insertable cardiac monitor (ICM). The occurrence over subsequent years is unknown.ObjectivesTo compare the rates of AF detection through 3 years of follow-up between an ICM vs site-specific usual care in patients with prior ischemic stroke attributed to LAD or SVD.Design, Setting, and ParticipantsThis multicenter, randomized (1:1) clinical trial took place at 33 sites in the US with enrollment between April 2016 and July 2019 and 3-year follow-up through July 2022. Eligible patients were aged 60 years or older, or aged 50 to 59 years with at least 1 additional stroke risk factor and had an index ischemic stroke attributed to LAD or SVD within 10 days prior to ICM insertion. Of the 496 patients enrolled, 492 were randomized and 4 were excluded.InterventionsICM monitoring vs site-specific usual care.Main Outcomes and MeasuresThe prespecified long-term outcome of the trial was AF detection through study follow-up (up to 3 years). AF was defined as an episode lasting more than 30 seconds, adjudicated by an expert committee.ResultsIn total, 492 patients were randomized and included in the analyses (median [IQR] age, 66 [60-74] years; 307 men [62.4%] and 185 women [37.6%]), of whom 314 completed 3-year follow-up (63.8%). The incidence rate of AF at 3 years was 21.7% (46 patients) in the ICM group vs 2.4% (5 patients) in the control group (hazard ratio, 10.0; 95% CI, 4.0-25.2; P < .001).Conclusions and RelevancePatients with ischemic stroke attributed to LAD or SVD face an increasing risk of AF over time and most of the AF occurrences are not reliably detected by standard medical monitoring methods. One year of negative monitoring should not reassure clinicians that patients who have experienced stroke will not develop AF over the next 2 years.Trial RegistrationClinicalTrials.gov Identifier: NCT02700945
Publisher
American Medical Association (AMA)
Subject
Neurology (clinical)
Cited by
5 articles.
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