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NEUROLOGY 2009;72:346-353
© 2009 American Academy of Neurology

Epidemiology of ischemic stroke from atrial fibrillation in Dijon, France, from 1985 to 2006

Y. Béjot, MD, D. Ben Salem, MD, G. V. Osseby, MD, G. Couvreur, MD, J. Durier, PhD, C. Marie, PhD, Y. Cottin, MD, T. Moreau, MD and M. Giroud, MD

From Stroke Registry of Dijon (Inserm et Institut de Veille Sanitaire) (Y.B., G.V.O., G.C., J.D., T.M., M.G.), EA4184, University Hospital and Faculty of Medicine and Department of Neurology; Department of Neuroimaging (D.B.S.), University Hospital, Dijon; Laboratory of Pharmacodynamics (C.M.), Inserm U887, University of Burgundy, Dijon; and Department of Cardiology and Observatoire des Infarctus de Côte-d'Or (RICO) (Y.C.), LPPCE, IFR Santé-STIC, University of Burgundy, University Hospital and Faculty of Medicine of Dijon, France.

Address correspondence and reprint requests to Dr. Yannick Bejot, Dijon Stroke Registry–Department of Neurology, University Hospital, 3 Rue du Faubourg Raines, 21000 Dijon, France ybejot{at}yahoo.fr

Background: Atrial fibrillation (AF) is strongly associated with age, and epidemiologic studies are needed to evaluate the impact of both aging of the population and the use of anticoagulant therapy in patients with AF on the incidence of cardioembolic stroke with AF (CE/AF stroke).

Methods: We evaluated trends in incidence rates, risk factors, prestroke therapy, and survival in CE/AF stroke from a prospective population-based registry, from 1985 to 2006.

Results: A total of 3,064 ischemic strokes, including 572 (18.7%) CE/AF strokes, were recorded. Over the 22 years, a decrease in the incidence of overall CE/AF stroke was noted (incidence rate ratio 0.9858, 95% confidence interval [CI] 0.9731–0.9986; p = 0.03). We observed a higher prevalence of previous AF, previous myocardial infarction, and patients aged >70 years in CE/AF stroke (p < 0.0001) whereas hypercholesterolemia was more prevalent in other ischemic strokes (p = 0.003). A significant increase in the use of anticoagulants and antiplatelet agents was noted, and was particularly pronounced for CE/AF stroke with previous AF. For CE/AF stroke, survival rates were 72% at 1 month (95% CI 0.68–0.76), 52% at 1 year (95% CI 0.48–0.56), and 43% at 2 years (95% CI 0.39–0.48), and remained lower than those of other ischemic stroke.

Conclusions: The decrease in the incidence of cardioembolic/atrial fibrillation stroke in our study was probably due to a slight increase in the utilization of antithrombotic therapy in patients with atrial fibrillation, but the use of such therapies will have to increase further because of the expected aging of the population in coming years.

AF = atrial fibrillation; CE = cardioembolic; CI = confidence interval; IRR = incidence rate ratios.

Supplemental data at www.neurology.org

Disclosure: The authors report no disclosures.

Received July 15, 2008. Accepted in final form October 15, 2008.






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