Lubitz Steven A, Yin Xiaoyan, McManus David D, Weng Lu-Chen, Aparicio Hugo J, Walkey Allan J, Rafael Romero Jose, Kase Carlos S, Ellinor Patrick T, Wolf Philip A, Seshadri Sudha, Benjamin Emelia J
From the Cardiovascular Research Center (S.A.L., L.-C.W., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.R.R., P.A.W., S.S., E.J.B.); Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester (D.D.M.); Boston University School of Medicine, MA (H.J.A., J.R.R., P.A.W., S.S., E.J.B.); Department of Neurology, Boston Medical Centre, MA (H.J.A., J.R.R., C.S.K., S.S.); Pulmonary Center and the Section of Pulmonary and Critical Care Medicine, Department of Medicine (A.J.W.) and Preventive Medicine Section, Department of Medicine (E.J.B.), Boston University School of Medicine, MA; and Section of Cardiovascular Medicine and Department of Epidemiology, School of Public Health, Boston University, MA (E.J.B.).
Stroke. 2017 Feb;48(2):490-492. doi: 10.1161/STROKEAHA.116.015071. Epub 2017 Jan 12.
To prevent strokes that may occur as the first manifestation of atrial fibrillation (AF), screening programs have been proposed to identify patients with undiagnosed AF who may be eligible for treatment with anticoagulation. However, the frequency with which patients with AF present with stroke as the initial manifestation of the arrhythmia is unknown.
We estimated the frequency with which AF may present as a stroke in 1809 community-based Framingham Heart Study participants with first-detected AF and without previous strokes, by tabulating the frequencies of strokes occurring on the same day, within 30 days before, 90 days before, and 365 days before first-detected AF. Using previously reported AF incidence rates, we estimated the incidence of strokes that may represent the initial manifestation of AF.
We observed 87 strokes that occurred ≤1 year before AF detection, corresponding to 1.7% on the same day, 3.4% within 30 days before, 3.7% within 90 days before, and 4.8% ≤1 year before AF detection. We estimated that strokes may present as the initial manifestation of AF at a rate of 2 to 5 per 10 000 person-years, in both men and women.
We observed that stroke is an uncommon but measureable presenting feature of AF. Our data imply that emphasizing cost-effectiveness of population-wide AF-screening efforts will be important given the relative infrequency with which stroke represents the initial manifestation of AF.
为预防可能作为心房颤动（AF）首发表现而发生的卒中，已提出筛查计划，以识别可能适合接受抗凝治疗的未确诊AF患者。然而，AF患者以卒中作为心律失常首发表现的频率尚不清楚。
我们通过统计在首次检测到AF当天、之前30天内、90天内和365天内发生卒中的频率，估计了1809名基于社区的弗明汉心脏研究参与者中，首次检测到AF且既往无卒中的患者中，AF可能以卒中形式出现的频率。利用先前报道的AF发病率，我们估计了可能代表AF首发表现的卒中发病率。
我们观察到在AF检测前≤1年发生的87例卒中，对应于在AF检测当天为1.7%，在之前30天内为3.4%，在之前90天内为3.7%，在AF检测前≤1年为4.8%。我们估计，无论男性还是女性，卒中可能以AF首发表现的发生率为每10000人年2至5例。
我们观察到卒中是AF一种不常见但可测量的表现特征。我们的数据表明，鉴于卒中作为AF首发表现相对少见，强调全人群AF筛查工作的成本效益将很重要。
