The secondary objective was to calculate the CHA2DS2Vasc score to estimate the number of patients at high risk of TE and requiring anticoagulation according to current guidelines. The main objective of the present prospective study based on 2008 data was to evaluate the prevalence of atrial arrhythmia (AA) (atrial fibrillation/flutter) and the impact of implementation of prevention guidelines on CHADS2 scores in a stroke population. Implementation seems to have an impact on the prescription of vitamin K antagonist (VKA). AF prevention guidelines based on clinical practice and the literature have been published and updated since 2001. Given the aging population, there is a rise in the number of AF patients. ĭuring the last 20 years, few population-based studies have focused on the prevalence of arrhythmia in stroke. In the 1990s, before the publication of AF prevention guidelines, epidemiological studies estimated prevalence of AF-related stroke at about 15 %. TE risk in atrial flutter has been less well assessed than in AF, but is estimated to be intermediate compared to sinus rhythm or AF. Despite its proven benefit, warfarin is underused in AF patients, and in particular in the elderly. Thromboprophylaxis in AF requires assessment of both stroke and bleeding risks. The risk of thromboembolism (TE) was evaluated on the basis of CHADS2 score ( Congestive heart failure, Hypertension, Age > 75 years, Diabetes mellitus, and prior Stroke or transient ischemic attack) scores in 20 the CHADS2 score was replaced by CHA2DS2 Vasc in 2010. American (ACC/AHA) and European (ESC) guidelines have been established for clinical practice. Warfarin has been shown to be highly effective in preventing stroke in AF. AF is commonly associated with other risk factors for stroke: age, female gender, hypertension, prior stroke or transient ischemic attack (TIA), systolic congestive heart failure, diabetes mellitus, and vascular disease. Stroke due to AF shows higher mortality and worse outcome than stroke due to atherosclerosis. AF is associated with increased risks of: mortality, heart failure, dementia and systemic embolism, with a 5-fold increase in risk of stroke. Given the aging population, the number of patients with AF is expected to rise. In population-based studies, incidence increased from 1.5 % after 80 years. Prevalence increases with age, from 10 % at 80 years or older. Despite publication of AF prevention guidelines, VKA prescription and use in elderly patients were significantly low.Ītrial fibrillation (AF) is a public health problem because of its epidemiology and severity: it is the most common form of cardiac arrhythmia, affecting approximately 1 % of adults. The prevalence of AA in the population-based Brest Stroke Registry in 2008 was higher than that reported by studies conducted 20 years ago. 54 of the 152 patients with CHADS2 score ≥ 2 (35.5 %) were treated with VKA this proportion decreased with age: 50 % between 50 and 74 years, 43.8 % between 75 and 84 years, and 25 % at 85 years and older. At time of stroke, AA was known in 207 patients (78.4 %). In patients with AA, 231 strokes were ischemic, 28 hemorrhagic and 5 undetermined. The prevalence of AA was 31.7 % ( n = 264), and increased with age from < 20 % in patients aged 45 to 54 years to nearly 50 % in patients ≥ 85 years. ResultsĨ51 cases of stroke were identified. Guidelines implementation was assessed in terms of antithrombotic therapy (VKA, antiplatelet agent, none), and the CHADS2 ( Congestive heart failure, Hypertension, Age > 75 years, Diabetes mellitus, and prior Stroke or transient ischemic attack). The prevalence of AA was studied in patients diagnosed with stroke from January 1 to Decemin the population-based Stroke Registry of Brest, France (total population, 363,760 according to the 2008 census, with 295,553 aged 15 years or older). The objective of the present prospective study, using data from 2008, was to evaluate the prevalence of AA (atrial fibrillation/flutter) in patients with stroke and the impact of implementing AF guidelines. During the last 20 years, few population-based studies have focused on the prevalence of atrial arrhythmia (AA) in patients with stroke. In the 1990s, epidemiological studies estimated the prevalence of stroke caused by atrial fibrillation (AF) at about 15 %.
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