Impact of atrial fibrillation among stroke patients in a Malaysian teaching hospital

OBJECTIVES: Atrial fibrillation (AF) is a well-recognised, major risk factor for ischaemic stroke. The presence of atrial fibrillation in a stroke patient translates into higher mortality rates and significant disability. There is lack of data on the impact of atrial fibrillation on stroke patients in Malaysia. The aim of this study was to determine the prevalence of AF in a hospital setting and determine the risk factors, clinical profile and discharge outcomes in ischaemic stroke patients with and without atrial fibrillation from a tertiary centre in Malaysia.
METHODS: This was a retrospective review of patients admitted consecutively to the University Malaya Medical Centre, Kuala Lumpur with the diagnosis of stroke during the first six months of 2009. The presence of AF was confirmed with a 12- lead ECG. All patients had neuroimaging with either cranial computed tomography (CT) or magnetic resonance imaging (MRI). Other variables such as clinical features, risk factors, stroke subtypes, length of acute ward stay, complications and evaluation at discharge (mortality) with modified Rankin scale (mRS) were also recorded.
RESULTS: A total of 207 patients were admitted with stroke during the study duration. Twenty two patients (10.6%) were found to have non valvular AF. Patients with AF were found to be older with a mean age of 71.0 ± 2.2 than those without AF with a mean age of 63.6 ± 0.89 (p<0.05). Risk factors for stroke such as diabetes mellitus and hypertension were equally common between the two groups while the proportion of patients with ischaemic heart disease was higher among patients with AF (p<0.005). Most of the stroke subtypes among patients with AF were of ischaemic type (n=192; 92.8%) while haemorrhagic stroke was uncommon (n=15; 6.2%). Patients with AF had a longer median hospital stay, higher mortality rate and greater functional disability on hospital discharge compared to non AF patients.
CONCLUSION: The prevalence of AF among stroke patients in a tertiary centre in Malaysia was 10.6%. Stroke patients with AF were observed to have a higher mortality rate and disability on hospital discharge.
Study site: University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia