Source: European Stroke Journal; May 2017; vol. 2 (no. 1); p. 438-439
Publication Date: May 2017
Publication Type(s): Conference Abstract
Abstract:Background and Aims: Among the elderly population, atrial fibrillation (AF) is the most prevalent chronic arrhythmia. The overall lifetime-risk of AF is 23%. This cohort of patients are 4-5 times more susceptible to strokes which are likely to be fatal or associated with poorer neurological outcomes. Method: Patients presenting with strokes to East-Lancashire-NHSHospital-Trust (ELHT) are admitted directly to the Acute-Stroke-Unit (ASU) and their data are recorded on The Sentinel Stroke National Audit Programme (SSNAP). AF-related stroke cases were audited and included in this study. Results: 613 patients with strokes were investigated in this observational study, 110 of them were secondary to AF. 93% (102) were known-AF while 7% (8) had new-onset AF. 16%(18) of them, did not survive. Their mean age was 83. 89%(16)had a history of AF. 50% (9) were not anticoagulated, 33.3% (6) were on Warfarin while 11% (2) were on Dabigatran. One third of those who weren't anti-coagulated, had a HASBLED-3. Of the 110 with AF-related strokes, 37%(41) were not anti-coagulated on presentation. 22%(9) of them died during their admissions. In the cohort of 32 who were not anti-coagulated but survived, 12 had a high-risk of bleeding (i.e HASBLED-3). Conclusion: Despite the high mortality associated with AF-related strokes, significant number of patients are still not on anti-coagulation. Predicting bleeding events among patients remains a clinical challenge. Many clinicians are using the HASBLED score as means to justify not anti-coagulating rather than using the calculator to highlight patients in whom caution with therapy and regular review is required.