Mortality After Acute Stroke Worsened by Accompanying Acute AF


Why This Matters

  • A comprehensive understanding of the relationship between acute AF and risk for acute ischemic stroke and prognosis will help improve management and treatment of patients with acute ischemic stroke.

Study Design

  • The retrospective study included patients with acute ischemic stroke within the prior 24 hours; 12-lead electrocardiogram in the emergency department; and hospitalization and treatment at the hospital stroke center.

  • The cohort of 706 patients admitted to a single center in Shanghai, China, from December 2019 to December 2021, included 142 with episodes of acute AF and 564 without such episodes.

  • Patients with acute ischemic stroke and acute AF — including AF of new onset, paroxysmal, persistent, or permanent with symptoms such as palpitations or dizziness attributed to rapid ventricular rates — were identified.

  • Neurological deficits were assessed using the 7-day National Institutes of Health Stroke Scale/Score (NIHSS). Patients with a 7-day NIHSS score of at least 16 were considered to have moderate-to-severe stroke.

  • Associations between acute AF onset and the severity of early neurological deficits were assessed and related to all-cause mortality within 30 days of the stroke.

Key Results

  • Patients with acute AF were older than those without acute AF (80.3 y vs 71.0 y; < .001).

  • Baseline NIHSS scores averaged 16.09 for the stroke patients with acute AF and 8.65 for those without acute AF (< .001).

  • Significantly more patients with acute AF than without acute AF had a 7-day NIHSS score of at least 16 (45.1% vs 14.4%; P < .001).

  • More patients with than without acute AF underwent transcatheter thrombectomy (44.4% vs 24.5%; < .001) or received thrombolytic therapy (31.6% vs 19.7%; = .005).

  • Patients aged 73 years or older showed baseline NIHSS score and acute AF as independent risk factors for early neurological deficits in stroke patients admitted to the emergency department.

  • Mortality at 30 days was significantly higher in patients with acute AF than in those without acute AF (30.3% vs 10.1%; < .001).

  • Baseline NHISS had an adjusted odds ratio for 30-day mortality of 1.18 (95% confidence interval [CI], 1.15 - 1.22; < .001).  

  • Other independent predictors included acute AF (1.87 [95% CI, 1.09 - 3.19; = .022]) and age 73 or older (2.00 [95% CI, 1.18 - 3.37; = .01]).


  • The study was retrospective and didn't have access to some potentially relevant data, such as duration of AF.

  • The single-center study with limited generalizability does not necessarily represent the broad population of stroke patients in China or elsewhere.


  • This study was supported by the Cardiovascular Multidisciplinary Integrated Research Fund and Construction of Shanghai Municipal Health Commission.

  • The authors report no relevant financial relationships.