Are we missing an opportunity? Prehospital delay in patients with acute ischemic stroke and known atrial fibrillation

Marta Magriço; Miguel Serôdio; João Nuno Ramos; Rita Ventura; André Sobral-Pinho; João Pedro Marto; Miguel Viana-Baptista

doi:10.1016/j.repc.2023.11.005

Are we missing an opportunity? Prehospital delay in patients with acute ischemic stroke and known atrial fibrillation

Rev Port Cardiol. 2024 Feb 21:S0870-2551(24)00065-9. doi: 10.1016/j.repc.2023.11.005. Online ahead of print.

[Article in English, Portuguese]

Authors

Marta Magriço¹, Miguel Serôdio², João Nuno Ramos³, Rita Ventura¹, André Sobral-Pinho¹, João Pedro Marto⁴, Miguel Viana-Baptista⁴

Affiliations

¹ Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
² Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal. Electronic address: maserodio@chlo.min-saude.pt.
³ Department of Neuroradiology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
⁴ Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; Chronic Diseases Research Centre (CEDOC), Faculdade de Ciências Médicas|NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.

PMID: 38395298
DOI: 10.1016/j.repc.2023.11.005

Abstract

Introduction and objectives: The follow-up of patients with atrial fibrillation (AF) presents an opportunity to alert patients and their families on how to recognize and act in the event of stroke. Our aim was to compare stroke recognition-to-door time and prehospital stroke code activation in patients with known AF (KAF) and AF detected after stroke (AFDAS).

Methods: We performed a retrospective cohort study of consecutive patients receiving acute recanalization treatment for acute ischemic stroke between January 2016 and August 2022, with AF as a potential stroke cause. Patients were divided into KAF and AFDAS, and stroke recognition-to-door time and prehospital stroke code activation were compared. In the KAF subgroup, we assessed whether the use of preadmission anticoagulation was associated with the studied prehospital parameters.

Results: We included 438 patients, 290 female (66.2%), mean age 79.3±9.4 years. In total, 238 patients had KAF (54.3%) and 200 (45.7%) had AFDAS. Of those with KAF, 114 (48.1%) were pretreated with anticoagulation. Patients with KAF and AFDAS had no differences in stroke recognition-to-door time (74.0 [55.0-101.0] vs. 78.0 [60.0-112.0] min; p=0.097) or prehospital stroke code activation [148 (64.6%) vs. 128 (65.3%); p=0.965]. In the KAF subgroup, preadmission anticoagulation did not influence stroke recognition-to-door time or mode of hospital admission.

Conclusion: Stroke recognition-to-door time and prehospital stroke code activation were similar between patients with known or newly diagnosed AF. Preadmission anticoagulation treatment also did not affect the studied parameters. Our findings highlight a missed opportunity to promote stroke knowledge in patients followed due to AF.

Keywords: Acidente vascular cerebral isquémico; Acute ischemic stroke; Atrial fibrillation; Conhecimento sobre AVC; Fibrilhação auricular; Reconhecimento de AVC; Stroke code activation; Stroke knowledge; Stroke recognition; Via Verde AVC.