New Study in Advances in Atrial Fibrillation-related Stroke Prevention Proceedings of a Symposium Presented at the European Stroke Conference, in Nice, France, 8 May 2014

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European Neurological Review (Touch Medical Media), a peer-reviewed, open access, bi-annual neurology journal, publish cutting-edge article by Pierre Amarenco, Werner Hacke, Bo Norrving, Natalia Rost.

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In patients with atrial fibrillation (AF) the risk of stroke is substantially increased, especially in those who are elderly (over 75 years) or have risk factors such as previous stroke, heart failure or hypertension.

Atrial fibrillation (AF), the most common type of cardiac arrhythmia, substantially increases the risk and severity of stroke and has a highly negative effect on patient outcomes. AF is associated with a pro-thrombotic state and studies have shown it increases the risk of stroke fivefold. This increased risk is particularly great in the elderly aged ≥80 years in whom stroke occurrence is up to 45.8 %. AF is also associated with an increased severity of stroke and the proportion of patients with cardio-embolic stroke is markedly increased with a 30-day mortality of 25 %. Furthermore, the presence of AF with stroke almost doubles the death rate with a 1-year mortality of 50 %. Although these risks are well recognised, too few patients with AF receive preventative and adequate therapy to minimise their stroke risk. As a consequence, there is unnecessary morbidity and mortality. This article reports presentations and discussions from a satellite symposium to discuss the important and timely matter of stroke prevention in AF, which was convened at the 23rd European Stroke Conference held in Nice in May 2014.

Prevention of Atrial Fibrillation-related Stroke – Guidelines and Clinical Reality
Professor Werner Hacke (University of Heidelberg, Germany) considered the current recommendations for treating AF and how well these are being adhered to in Europe and elsewhere.

The Current Recommendations and Stroke Risk Classification
The European guidelines, established for over a decade, have identified the increased stroke risk in AF and set out strategies to minimise it. In the clinical classification scheme for predicting stroke (CHADS2) factors such as congestive heart failure, hypertension, age ≥75 years and diabetes each score 1 point and a previous stroke or transient ischaemic attack (TIA) scores 2 points. The sum of these points increases with stroke risk: total scores in the range 0 to 6 represent 1.9 to 18.2 strokes/100 patient years (without anticoagulant therapy).

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