Demographic and clinical profile of cardioembolic stroke patients in Western Sydney

• DOI: 10.1111/imj.14416
• Publication Date: 2019-07-01T17:56:57Z
• Authors: Aaisha Ferkh; Emily O'Keefe; Matthew Zada; Paula Brown; Andrew Duggins; Aravinda Thiagali...; Mikhail Altman; Karen Byth; Eddy Kizana; Alan R. Denniss; Liza Thomas
• Keywords: Male; Embolic Stroke; Brain Ischemia; 3. Good health; Stroke; 03 medical and health sciences; 0302 clinical medicine; Risk Factors; Atrial Fibrillation; Humans; Female; Demography; Retrospective Studies

AbstractBackgroundCardioembolism (CE) contributes to a large proportion of ischaemic stroke.AimsTo evaluate the demographic and clinical profile of CE stroke in Western Sydney.MethodsA retrospective analysis of ischaemic stroke patients presenting to Westmead Hospital (January–October 2016) was performed. Strokes were classified by TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria into different categories. Clinical and demographic data were collected on all stroke patients, and differences between CE and other stroke causes were identified.ResultsTwo hundred and twenty‐eight consecutive patients (70.9 years; 53% male) were identified. By TOAST criteria, 21 (9%) had large‐artery atherosclerosis, 94 (41%) CE, 10 (5%) small‐vessel disease, 2 (1%) other aetiology and 101 (44%) undetermined aetiology. A significant proportion of CE stroke patients had cardiovascular risk factors including hypertension (66%), hypercholesterolaemia (50%), diabetes (26%) and ischaemic heart disease (28%). The majority (81%) of patients with CE had atrial flutter/flutter. CE stroke, compared with other types of stroke, was more common in females (56 vs 41%, P = 0.022) and patients with CE stroke were more likely to have previous cerebral ischaemia (34 vs 21%, P = 0.026), suggesting increased recurrence in this group. Of the patients with atrial flutter/flutter (n = 56), the majority (87%) had a high CHA2DS2‐VASC score (≥2); however, a significant proportion (55.4%) were not on anticoagulation.ConclusionsCardioembolic stroke remains a significant burden in Western Sydney, and it is likely that a significant proportion may be preventable, as evidenced by the substantial presence of modifiable cardiovascular risk factors, and inadequate anticoagulation of patients with atrial arrhythmias.