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1 Clinical Characteristics of Emergency Department Patients Presenting with Transient Ischemic Attack in the Stti Setting of Atrial Fibrillation ato CAEP Niagara Falls June 2012
2 Ryan D.H. Tam, MS2 Jeffrey J. Perry, MD Ian G. Stiell, MD Jane Sutherland, MEd Marco L.A. Sivilotti, MD Marcel Émond, MD Andrew Worster, MD Grant Stotts, MD Mukul Sharma, MD Department of Emergency Medicine Ottawa Hospital Research Institute University of Ottawa, Ottawa, ON Queens U, Kingston, ON; McMaster U, Hamilton, ON; Laval U, Quebec, QC Funded by Canadian Institutes of Health Research
3 Disclosures I have no potential conflict of interest in relation to I have no potential conflict of interest in relation to this research or presentation
4 TIA and Stroke Acute high risk of stroke immediately after transient ischemic attack Hill MD et al Neurology. 62(11): , 2004 Jun 8.
5 Atrial Fibrillation Prevalence Prevalence of atrial fibrillation according to age and sex Marini C et al. Stroke 2005;36:
6 Atrial Fibrillation and Stroke Higher risk of recurrent stroke in those with AF and Stroke Lin H et al. Stroke 1996;27:
7 Atrial Fibrillation and Stroke AF Non AF P value 3 Months (n = 12) (n = 49) Mean ± SE 49.7 ± ± Dependence Level Severe 58.3% 16.3% Moderate 16.7% 20.4%.009 Mild/none 25.0% 63.3% Barthel Index during follow up after stroke adapted from Lin H et al. Stroke 1996;27:
8 TIA with Atrial Fibrillation Little is known aboutthosewith those atrial fibrillationand and TIA Atrial fibrillation may be paroxysmal, and therefore not present on initial iti lecg TIA in the setting of atrial fibrillation is an indication for anticoagulation
9 Objectives Identify TIA individuals and event characteristics that predict a high probability of underlying atrial fibrillation ill i Identify rates of subsequent stroke and mortality at 7 and 90 days in TIA individuals with or without atrial fibrillation
10 Methods Study Design: Prospective cohort study Study Sites: Eight Canadian emergency departments ( ) Inclusion Criteria: >18 years with a diagnosis of TIA or minor stroke Data Collection by ED Physician: Patient characteristics, clinical symptoms, investigations 7 and 90 Day Follow up: All events reviewed by blinded Adjudication Committee
11 Methods Identification of Atrial Fibrillation: 12 lead ECG Holter monitor after initial assessment Echocardiogram History of atrial fibrillation Outcomes (7 and 90 days): Primary outcomes: subsequent stroke, mortality Secondary outcomes: TIA, myocardial infarction Univariate Analysis
12 Results 3,298 (77.6% of eligible) Patients Enrolled 379 (11.5%) Patients were Identified with Atrial fibrillation Atrial Fibrillation p value a Yes No Age 76.51± ±14.4 <0.001 Male % 50.0% 50.0% Stroke/TIA History % 21.5% 12.4% <0.001 Hypertension % 71.1% 57.6% < Diabetes % 21.0% 18.6% Dyslipidemia % 39.0% 32.6% Smoking % 8.0% 13.8% Coronary Artery Disease % 31.3% 17.1% <0.001 Congestive Heart Failure % 13.0% 1.6% <0.001 Valvular Heart Disease % 9.8% 2.7% <0.001
13 Results Co morbidities Significantly more Prevalent with Atrial Fibrillation: Age History of stroke/tia Hypertension Dyslipidemia Coronary Artery Disease Heart Failure Valvular Heart Disease
14 No significant values found with duration of symptoms Atrial Fibrillation p value a Signs/Symptoms Yes No Motor 50.7% 46.7% Speech 53.0% 38.8% <0.001 Visual 17.2% 17.0% Visual Field Defect 3.4% 3.2% Vision Loss in 1 Eye 5.5% 5.5% Vertigo/Dizziness 24.3% 27.5% Gait Change 16.0% 12.3% Sensory 36.4% 47.5% <0.001
15 Results Significantly more Prevalent Clinical/Imaging g Findings: Speech symptoms Sensory symptoms Cerebral latrophy on CT Old Infarct on CT
16 Increased Rates of Stroke and Mortality at 90 Days with Atrial Fibrillation
17 Limitations Management of the patients were not controlled Treatment based on diagnosis by ED physician Univariate Analysis
18 Conclusions Profile of TIA Patient Likely to Have Atrial Fibrillation: Older Heart disease (Valvular, Heart Failure) Speech affected Not sensory Atrophy and old infarcts on CT There is a need to identify TIA patients with atrial fibrillation to optimize care given this group has Mortality and Stroke at 90 days Implications: Individuals with a high risk profile may warrant increased suspicion of AF and further investigation.
19 Acknowledgements Dr. Perry Dr. Stiell Ms. J. Sutherland Dr. Sivilotti Dr. Emond Dr. Worster Dr. Stotts Dr. Sharma
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