Outcomes after an atrial fibrillation-related stroke 

Mortality after an AF-related stroke

About 50% of people die within a year of a atrial fibrillation (AF)-related stroke. This compares with a mortality rate of 27% among people with strokes unrelated to AF.12 A study from Ireland reported five-year survival rates after an AF-related stroke of 39.2%.23

AF-related strokes tend to produce large, multiple infarcts that may involve several vascular beds.12 This might partly explain why outcomes after an AF-related stroke can be particularly poor. AF-related stroke is, for instance, associated with a 50% higher risk of serious disability than stroke from other causes.2 A study from Ireland reported that 25.9% of patients were admitted to a nursing home after an AF-related stroke.23 

Recurrences are also common underscoring the importance of secondary prevention with oral anticoagulants in AF patients. In the study from Ireland the five-year survival rates after an AF-related stroke of 39.2% and a five-year recurrence rate was 21.5%.23

Between 10% and 15% of AF patients show cognitive dysfunction, including vascular dementia, double the rate in patients without the arrhythmia. In part, these cognitive disturbances follow a stroke or TIA. About a fifth of people aged 85 years show cerebral infarctions on computed tomography. However, half of these did not show clinical symptoms.24 Between 15% and 50% of AF patients show silent cerebral infarctions.24 In addition, many AF patients show multiple asymptomatic cerebral emboli on cerebral imaging, which may also contribute to cognitive dysfunction.2 Nevertheless, silent cerebral infarctions are associated with impaired cognition, neurological deficits, psychiatric disorder and an increased stroke risk.24

The next section summarises the pathogenesis of atrial fibrillation


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