Clinical Characteristics and Treatment Outcomes of Acute Ischemic Stroke with Atrial Fibrillation Among Patients Admitted to Tertiary Care Hospitals in Amhara Regional State: Retrospective-Cohort Study

Figures & data

Figure 1 Flow chart showing a selection of patients diagnosed with acute ischemic stroke in two hospitals from November 2018 to November 2021.

Figure 2 Kaplan-Meier estimate of survival rates in patients with atrial fibrillation and patients without atrial fibrillation.

Table 1 Socio-Demographic Characteristics of Patients Diagnosed with AIS from FHSCH and TGSCH from November 2018 to November 2021 (n=378)

Socio-Demographic Characteristic		AIS Plus AF (102)	AIS Alone (276)	Total 378 (%)
Sex	Male	48 (47.1%)	174 (63%)	222 (58.7%)
	Female	54 (52.9%)	102 (37%)	156 (41.3%)
Age	<= 53	19(18.6%)	60 (21%)	79 (20.9%)
	54–64	11 (10.8%)	61 (22.1%)	72 (19%)
	65–74	35 (34.3%)	83 (30.1%)	118 (31.2%)
	75–84	28 (27.5%)	64 (23.2%)	92 (24.3%)
	≥85	9 (8.8%)	8 (2.9%)	17 (4.5%)
Marital status	Single	7 (6.9%)	5(1.8%)	12 (3.2%)
	Married	66 (64.7%)	208(75.4%)	274 (72.5%)
	Divorced	1 (1%)	10 (3.6%)	11 (2.9%)
	Widow	28 (27.5%)	53(19.2%)	81 (21.4%)
Residency	Urban	43(42.2%)	91(33%)	134 (35.4%)
	Rural	59(57.8%)	185(67%)	244 (64.6%)
Religion	Orthodox	82 (80.4%0	235 (85.1%)	317 (72.5%)
	Protestant	13 (12.7%)	24 (8.7%)	37 (9.8%)
	Muslim	7 (6.9%)	15 (5.4%)	22 (5.8%)
	Catholic	0 (0.0%)	2 (0.7%)	2 (0.5%)
Educational status	No formal education	69 (67.6%)	195 (70.7)	264 (69.8%)
	Primary school (1–8)	7 (6.7%)	31 (11.2%)	38 (10.1%)
	Secondary school (9–12)	12 (11.8%)	23 (8.3%)	35 (9.3%)
	College/university	14 (13.7%)	27 (9.8%)	41 (10.8%)
Employment level	Employed	13 (12.7%)	26 (9.4%)	39 (10.3%)
	Farmer	47 (46.1%)	157 (56.9%)	204 (54%)
	Unemployed	20 (19.6%)	35 (12.7%)	55 (14.6%)
	Housewife	17(16.7%)	30 (10.9%)	47 (12.4%)
	Self-employed	5 (4.9%)	28 (10.1%)	33 (8.7%)

Table 2 Baseline Characteristics of Acute Ischemic Stroke Patients with Atrial Fibrillation and Those Without Atrial Fibrillation (n=378)

Variables	Category	ECG Finding		Chi-Square p-value
		AIS Plus AF	AIS Alone
Sex	Female	54 (52.9%)	102(37%)	0.005
Mean age		65.75 ±16.4	63.5±13.58	0.022
Age	< 54	19(18.6%)	60(21.7%)	0.016
	54–64	11 (10.8)	61 (22.1%)
	65–74	35 (34.3)	83 (30.1%)
	75–84	28 (27.3%)	64 (23.2%)
	>85	9 (8.8%)	8 (2.9%)
Time from symptom onset to hospital	<= 3 hours	3 (2.9%)	10 (3.6%)	0.747
	>3 hours	99 (97.1%)	266 (96.4%)
LDL level	LDL<100	62 (23.2%)	16 (20.3%)	0.037
	LDL ≥100 mg/dl	126(66.7%)	63(79.7%)
Hypertensive status	Newly diagnosed HTN	7 (6.9%)	40 (14.5%)	0.027
	Known hypertensive patient	40 (39.2%)	124 (45.1%)
Alcohol	Current alcohol use	20 (21.1%)	83 (32.3%)	0.053
	Former drinker	16(16.8%)	26 (10.1%)
GCS	Mild (13–15))	2(2%)	184(66.6%)	0.000
	Moderate (9–12)	15(14.7%)	81(29.3%)
	Severe (<8)	85(83.3%)	11(4%)
Comorbidity	VHD	58(56.9%)	13 (4.7%)	0.000
	HHD	12(11.8%)	21 (7.6%)	0.204
	CHD	12 (11.8%)	11 (4%)	0.005
	DCMP	9(8.8%)	8(2.9%)	0.014

Abbreviations: LDL, low-density lipoprotein; GCS, Glasgow Coma Scale; VHD, valvular heart disease; HHD, hypertensive heart disease; CHD, coronary heart disease; DCMP, dilated cardiomyopathy; AIS, acute ischemic stroke; AF, atrial fibrillation.

Table 3 Comparison of Neurologic Deficits During Admission Among Patients with Acute Ischemic Stroke Patients Plus Atrial Fibrillation and Those without Atrial Fibrillation

Neurologic Deficits During Admission	AIS Plus AF	AIS Alone	Total
LOC	69 (67.6%)	116 (42.0%)	185
Hemiparesis	44(43.1%)	125(45.3%)	169
Aphasia	86 (84.3%)	249(90.2%)	335
Facial palsy	61(59.8%)	144(52.2%)	205
Weakness	99 (97.1%)	268(97.1%)	367
Urinary incontinence	26 (25.5%)	68 (24.6%)	94
Headache	41(40.2%)	118(42.8%)	159
Convulsions/ABM	11 (10.8%)	24(8.7%)	35
Swallowing difficulty/dysphagia	0(0.0%)	5(1.8%)	5
Loss of memory	0(0.0%)	1(0.4%0	1
Loss of vision	0(0.0%)	2(0.7%)	2
Bilateral hearing loss	0(0.0%)	1(0.4%)	1
Neck stiffness	0(0.0%)	1(0.4%)	1

Abbreviations: LOC, loss of consciousness; ABM, abnormal body movement.

Table 4 In-Hospital Treatment Prescribed of Patients with Acute Ischemic Stroke Plus Atrial Fibrillation and without Atrial Fibrillation

In Hospital Treatment	AIS Plus AF	AIS Alone	Total
Antiplatelet	95 (93.1%)	270 (98.2%)	365
Anticoagulant	39(38.2)	12 (4.4%)	51
Antihypertensive agents	22(21.6%)	87(31.6%)	109
Statins	101 (99%)	271 (98.5%)	372
Antidiabetic agents	6(5.9%)	11 (4%)	17
Antithrombotic	77 (75.5)	180(65.5%)	257
Ventricular rate controls	30 (29.4%)	2 (0.7%)	32
Antibiotics	42 (41.2%)	73 (26.5%)	115
Anticonvulsant	3 (2.9%)	12 (4.4%)	15
Potassium chloride supplement	7(6.9%)	10(3.6%)	17
Diuretics/osmotic agents	1(1%)	11(4%)	12
Antidepressants	0(0%)	3(1.1%)	3

Table 5 Stroke-Related Complications During Hospital Stay in a Patient with Acute Ischemic Stroke Plus Atrial Fibrillation and without Atrial Fibrillation

Variables	AIS Plus AF	AIS Alone	Chi-Square p-value
Aspirational pneumonia	43(42.2%)	79(28.7%)	0.013
Urinary tract infection	4(3.9%)	12(4.3%)	0.855
Urinary incontinence	2(2.4%)	7(3.7%)	0.571
Acute renal failure	23(22.5%)	9(3.3%)	0000
Hypokalemia	19(18.6%)	28(10.1%)	0.027
Acute gastrointestinal hemorrhage	3(2.8%)	5(1.8%)	0.498
Hemorrhagic transformation	12(11.8%)	12(4.3%)	0.009
Pulmonary embolism	2(2%)	0	NA
Post-stroke depression	2(2%)	4(1.4%)	0.724
Increase intracranial pressure	0	6.(6%)	0.133
Hospital-acquired pneumonia	1(1%)	6(2.2)	0.445
Deep venous thrombosis	1(1%)	3(1.1%)	0.928
Bedsore	1(1%)	4(1.4%)	0.723
In-hospital death	26(25.5%)	24(8.7%)	0.000

Table 6 Bivariate and Multivariate Cox-Regression Analysis Results to Predictors Contributing to Survival of Acute Ischemic Stroke Patients with Atrial Fibrillation and Those without Atrial Fibrillation (n=378)

Variables		Patient Status		CHR (95% CI)	P value	AHR (95% CI)	P value
		Died	Alive
Hypertension status	No hypertensive comorbidity	25	141
	Newly diagnosed	2	45	0.211 (0.05, 0.895)	0.108	0.226(0.027, 1.935)	0.175
	Known hypertensive patient	23	141	0.906 (0.514, 1.599)	0.735	1.293 (0.526, 3.177	0.575
LDL level	Lipid controlled (LDL<100)	6	72
	Lipid not controlled (LDL ≥100 mg/dl)	30	159	1.901 (0.784, 4.613)	0.155	1.361(0.506, 3.658)	0.541
GCS	Mild (13–15)	10	176
	Moderate (9–12)	14	82	1.838(0.809, 4.179)	0.146	1.924(0.532, 6.964)	0.319
	Severe (<8)	26	70	3.538(1.692, 7.4)	0.001	12.690(2.603, 61.873)	0.002*
NO DCMP		45	316
DCMP		5	13	1.910 (0.756, 4.828)	0.171	3.875 (0.995, 15.090)	0.051
No chronic liver disease		43	259
Chronic liver disease		3	4	3.343 (1.022, 10.936)	0.046	4.969 (1.192, 20.704)	0.028*
No HIV/AIDS		48	324
HIV/AIDS		2	4	2.678 (0.646, 11.095)	0.174	8.302 (1.585, 43.502)	0.012*
No aspirational pneumonia		12	243
Aspirational pneumonia		38	84	4.707 (2.442, 9.073)	0.000	2.602 (1.085, 6.242)	0.032*
No hypokalemia		30	301
Hypokalemia		20	27	3.767 (2.129, 13.618)	0.000	1.179 (1.112, 3.373)	0.013*
No acute renal failure		27	319
Acute renal failure		23	9	7.772 (4.436, 9.073)	0.000	6.114 (1.817, 20.576)	0.003*
No hemorrhagic transformation		39	315
Hemorrhagic transformation		11	13	3.425 (1.745, 6.723)	0.000	2.335 (0.783, 6.961)	0.128
Without atrial fibrillation		24	252
Atrial fibrillation		26	76	2.033 (1.156, 3.575)	0.014	1.104 (1.015, 5.404)	0.003*

Note: *The statistically significant predictor of mortality with p < 0.05 in multivariate Cox regression analysis.

Abbreviations: GCS, Glasgow Coma Scale; LDL, low-density lipoprotein; DCMP, dilated cardiac myopathy; AF, atrial fibrillation; AHR, adjusted hazard ratio; CHR, crude hazard ratio,