The rate of overall death from stroke has been halved in the last 20 years

15 May 2018

By June Shannon

A new Irish study has found that stroke patients with atrial fibrillation (AF) (abnormal heart beat) are more likely to die from their stroke than those without the condition, underlining the importance of diagnosing and treating AF.

The study, which is published in the latest issue of the Irish Medical Journal, also revealed that the rate of overall death from stroke has been halved in the last 20 years.

For the study researchers at Tallaght Hospital in Dublin, reviewed the medical charts of all patients who died in the hospital following an acute stroke in 2014 and 2015. They collected data on stroke type, aetiology, severity of symptoms, age, major comorbidities and length of stay. They then compared these results with data from all stroke patients in the service.

A total of 518 acute stroke patients were admitted to the stroke service in 2014 and 2015. The vast majority or 83 per cent, were cared for in the acute stroke unit, including 72 per cent of those who died.

The results revealed that almost half or 49 per cent of patients had atrial fibrillation and the death rate in patients with AF was 11 per cent, compared to 5.7 per cent in those without confirmed AF.

The death rate over the two-year period was 7.5 per cent. This was half that of the 15 per cent rate recorded in 1997-1998 when the service carried out its first audit, showing that death rates from stroke are reducing.

Interestingly. the study also revealed that seven patients who died from their stroke were also suffering with cancer.

According to the authors, “malignancy has been associated with an increased risk of both ischaemic and haemorrhagic strokes, and in-hospital mortality from stroke appears to be higher in these patients. While this may in part be explained by shared risk factors such as smoking and obesity, there are a number of other proposed mechanisms for the pathogenesis of stroke in cancer.”

The researchers questioned whether patients who present with cryptogenic stroke (cause is unknown) should be screened for undiagnosed cancer.

Commenting on the study, Dr Angie Brown Medical Director of the Irish Heart Foundation said, “This study shows stroke is still an important cause of mortality and morbidity and that AF is one if the main causes. However, the good news is death rates are falling and if AF is diagnosed it can be treated and the risk of stroke reduced.”

IMJ May 2018 Vol 111, Number 5