Functional outcome in stroke patients with atrial fibrillation

OBJECTIVES: To identify the prevalence of atrial fibrillation (AF) in a sample of stroke patients and to evaluate the impact of AF on patient clinical characteristics and functional outcome. DESIGN: A retrospective case-comparison study. SETTING: University-affiliated rehabilitation centers. PARTICIPANTS: One hundred ninety-six of 231 consecutive stroke patients admitted to inpatient rehabilitation units were evaluated during the rehabilitation period. MAIN OUTCOME MEASURES: Characteristics of cerebral lesions, patient demographic features, disease duration, length of hospital stay (LOS), risk factors for stroke, and functional status at admission and at discharge were assessed and compared in patients with and without AF. Functional Independence Measure (FIM) and Adapted Patient Evaluation Conference System (APECS) were used to evaluate functional status. RESULTS: AF was diagnosed in 41 (20.1%) patients. Patients who had AF were more likely to have ischemic cerebral lesions. There were no significant differences between the AF and non-AF groups with regard to mean age, LOS, and disease duration. Ischemic and valvular heart disease were more common in patients with AF. Based on FIM and APECS scores, both initial and discharge disability were more severe in patients with AF. In a multivariate model, AF was a negative prognostic factor for functional outcome in stroke patients. CONCLUSION: AF is not only associated with increased risk of stroke, but also with markedly greater disability in stroke patients. Factors such as size and type of cerebral lesions, stroke severity, comorbid conditions, and impact of AF on systemic and cerebral circulation can influence stroke recovery.