PT - JOURNAL ARTICLE AU - Anjali Bhatla AU - Yuliya Borovskiy AU - Ronit Katz AU - Matthew C. Hyman AU - Parin J. Patel AU - Jeffrey Arkles AU - David J. Callans AU - Neel Chokshi AU - Sanjay Dixit AU - Andrew E. Epstein AU - David S. Frankel AU - Fermin C. Garcia AU - Ramanan Kumareswaran AU - Jackson J. Liang AU - David Lin AU - Steven R. Messé AU - Saman Nazarian AU - Michael P. Riley AU - Pasquale Santangeli AU - Robert D. Schaller AU - Gregory E. Supple AU - Scott E. Kasner AU - Francis Marchlinski AU - Rajat Deo TI - Stroke, Timing of Atrial Fibrillation Diagnosis, and Risk of Death AID - 10.1212/WNL.0000000000011633 DP - 2021 Mar 23 TA - Neurology PG - e1655--e1662 VI - 96 IP - 12 4099 - http://n.neurology.org/content/96/12/e1655.short 4100 - http://n.neurology.org/content/96/12/e1655.full SO - Neurology2021 Mar 23; 96 AB - Objective To evaluate the prognosis of patients with ischemic stroke according to the timing of an atrial fibrillation (AF) diagnosis, we created an inception cohort of incident stroke events and compared the risk of death between patients with stroke with (1) sinus rhythm, (2) known AF (KAF), and (3) AF diagnosed after stroke (AFDAS).Methods We used the Penn AF Free study to create an inception cohort of patients with incident stroke. Mortality events were identified after linkage with the National Death Index through June 30, 2017. We also evaluated initiation of anticoagulants and antiplatelets across the study duration. Cox proportional hazards models evaluated associations between stroke subtypes and death.Results We identified 1,489 individuals who developed an incident ischemic stroke event: 985 did not develop AF at any point during the study period, 215 had KAF before stroke, 160 had AF detected ≤6 months after stroke, and 129 had AF detected >6 months after stroke. After a median follow-up of 4.9 years (interquartile range 1.9–6.8), 686 deaths occurred. The annualized mortality rate was 8.8% in the stroke, no AF group; 12.2% in the KAF group; 15.8% in the AFDAS ≤6 months group; and 12.7% in the AFDAS >6 months group. Patients in the AFDAS ≤6 months group had the highest independent risk of all-cause mortality even after multivariable adjustment for demographics, clinical risk factors, and the use of antithrombotic therapies (hazard ratio 1.62 [1.22–2.14]). Compared to the stroke, no AF group, those with KAF had a higher mortality risk that was rendered nonsignificant after adjustment.Conclusions The AFDAS group had the highest risk of death, which was not explained by comorbidities or use of antithrombotic therapies.AF=atrial fibrillation; AFDAS=atrial fibrillation detected after stroke; ECG=electrocardiogram; EHR=electronic health record; ICD-9=International Classification of Diseases–9; IQR=interquartile range; KAF=known atrial fibrillation; PAFF=Penn Atrial Fibrillation Free