Stroke Prevention and Atrial Fibrillation Management, Thoughts From STROKE-AF Study: Lee Shwamm, MD

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“For many years, we've known that patients who present symptoms and have atrial fibrillation detected are at a much higher risk of stroke than patients who are without. We know that anticoagulation with blood thinners dramatically reduced the risk of stroke on those patients.”

Research has shown that patients who experience atrial fibrillation (AF) are at a higher risk of stroke in comparison with patients who do not, and anticoagulation reduces the risk of stroke on those patients. Patients post-stroke aren’t normally monitored for AF; although, findings from the 3 year follow-up of the STROKE-AF trial(NCT02700945) suggest management for AF can prevent another stroke from occurring. Lead author Lee Schwamm, MD, presented the results as a late breaker at the 2023 International Stroke Conference (ISC), February 8-10, in Dallas, Texas.1 Findings showed that approximately 1 in 5 patients with ischemic stroke had AF after 3 years of observation.

Additional findings presented included an AF incidence rate of 21.7% in the insertable cardiac monitor (ICM) arm vs 2.4% standard of care (SOC) arm (HR, 10.0; 95% CI, 4.0-25.2; P <.001). Furthermore, the longest AF episode was 10.0 (IQR, 4.0-192.0) min on average among patients with ICM and AF. AF burden in patients with AF daily was 0.3 hours, with 1 in every 4 patients having AF longer than 5.3 hours. Notably, there were no significant difference in rates of recurrent stroke between the ICM and SOC arms (17.0% vs 14.1%; HR, 1.10; 95% CI, 0.67-1.78; P = .71).

Schwamm, professor of neurology at Harvard Medical School, sat down with NeurologyLive^® in an interview at the meeting to discuss the highlights from the STROKE-AF study including the prevention of stroke and atrial fibrillation management. In addition, he mentioned the findings from a study, CRYSTAL AF (NCT00924638), that had similar results with patients with AF. He also addressed the importance of the issue of atrial fibrillation in patients in how it could be a contributor to the future with stroke.

Click here for more coverage of ISC 2023.

REFERENCES
1. Schwamm LH, Kamel H, Sethi PP, et al. 3-year Results from the STROKE-AF Randomized Trial. Presented at: 2023 International Stroke Conference; February 8-10; Dallas, TX. LB1