A Simplified Risk Score to Predict In-Hospital Newly-Diagnosed Atrial Fibrillation in Acute Ischemic Stroke Patients

Abstract

Purpose

Atrial fibrillation (AF) is a significant cause of stroke, and newly diagnosed AF (NDAF) is typically detected in the early period of stroke onset. We aimed to identify the factors associated with in-hospital NDAF in acute ischemic stroke patients and developed a simplified clinical prediction model.

Methods

Patients with cryptogenic stroke aged 18 years or older who were admitted between January 2017 and December 2021 were recruited. NDAF was determined by inpatient cardiac telemetry. Univariable and multivariable regression analyses were used to evaluate the factors associated with in-hospital NDAF. The predictive model was developed using regression coefficients.

Results

The study enrolled 244 eligible participants, of which 52 NDAFs were documented (21.31%), and the median time to detection was two days (1–3.5). After multivariable regression analysis, parameters significantly associated with in-hospital NDAF were elderly (>75 years) (adjusted Odds ratio, 2.99; 95% confident interval, 1.51–5.91; P = 0.002), female sex (2.08; 1.04–4.14; P = 0.04), higher admission national institute of health stroke scale (1.04; 1.00–1.09; P = 0.05), and presence of hyperdense middle cerebral artery sign (2.33; 1.13–4.79; P = 0.02). The area under the receiver operating characteristic curve resulted in 0.74 (95% CI 0.65–0.80), and the cut-point of 2 showed 87% sensitivity and 42% specificity.

Conclusion

The validated and simplified risk scores for predicting in-hospital NDAF primarily rely on simplified parameters and high sensitivity. It might be used as a screening tool for in-hospital NDAF in stroke patients who initially presumed cryptogenic stroke.

Keywords:

• acute ischemic stroke
• newly diagnosed atrial fibrillation
• clinical prediction model
• risk scoring

Data Sharing Statement

The authors confirm that the data supporting the findings of this study are available within the article and its Supplementary Materials. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Ethical Approval and Informed Consent

The Research Ethics Committees of the Faculty of Medicine, Chiang Mai University, approved this study protocol (Study Code: MED-2565-08890). The requirement for informed consent was waived because the retrospective and non-interventional study collected data from the previous electronic medical record and did not involve personal privacy and commercial interests. The study involves no more than minimal risk to subjects, and the waiver will not adversely affect the rights and welfare of the subjects. The data were anonymized or maintained with confidentiality. The publication of this study follows the Declaration of Helsinki.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors have no conflicts of interest in this work to declare.

Additional information

Funding

No funding was received for carrying out this study and preparing the manuscript.