Systemic Thromboembolism and Stroke After Atrial Fibrillation and Atrial Flutter

In a recent study, published in Cureus, lead author, Harshith S. Thyagaturu, and colleagues examined the differences in risk for systemic thromboembolism (STE) or stroke after atrial fibrillation (AF) and atrial flutter (AFL)  requiring hospitalization. In their article, Thyagaturu and the study’s contributors suggested that “there is a decrease in the one-year risk of stroke or STE events in AFL patients compared to AF.” Additionally, the authors reported that predictors of stroke and STE in AFL were similar to predictors in AF, including increased age, previous stroke, hypertension, diabetes, and peripheral vascular disease.

STE and Stroke After Atrial Fibrillation Analysis Design

The analysis identified 215,810 patients with AF and 15,292 patients with AFL within the  2018 National Readmission Database (NRD) via ICD-10-CM codes, and followed them to the end of the calendar year or until readmission for STE or stroke after AF or AFL. Authors then calculated survival estimates and adjusted hazard ratios (aHR) to compare stroke and STE risk between the two arrhythmias.

According to the article, patients with AFL were more likely to be younger and male, and they had a higher prevalence of obesity, obstructive sleep apnea, diabetes mellitus, and alcohol use (p <0.01). Thyagaturu stated that, “after adjusting for potential patient and hospital-level characteristics, there was a statistically significant decrease in one-year stroke or STE readmission risk in AFL patients compared to AF patients (aHR = 0.79; 95% confidence interval [CI], 0.66–0 .95; p = 0.01).” Significant risk factors in the AFL cohort included increased age, female sex, hypertension, diabetes, previous stroke, and peripheral vascular disease, which are many of the same predictors for STE and stroke after AF.

Overall, the authors observed a reduced risk of stroke and STE in patients with AFL compared to those with AF, though they acknowledged that further exploration of risk factors is warranted, and ultimately concluded that “studies with anticoagulation information and longer follow-up periods are needed to verify the studies.”

Find more related research in the Atrial Fibrillation Knowledge Hub