Prevalence, Clinical Correlates, Management Patterns, and In-Hospital Outcomes of Atrial Fibrillation in Acute Ischemic Stroke: A Prospective Cohort Study from a Tertiary Care Center

Abstract

Objectives: To determine the prevalence of atrial fibrillation and evaluate its association with demographic characteristics, management strategies, and in-hospital outcomes in patients presenting with acute ischemic stroke. Methodology: This prospective observational cohort study was conducted at a tertiary care hospital in Karachi from June to December 2023. Adult patients with radiologically confirmed ischemic stroke were enrolled. Clinical characteristics, comorbidities, and treatment modalities were recorded. Atrial fibrillation was identified using electrocardiography and, where indicated, Holter monitoring. Functional outcomes at discharge were assessed using the modified Rankin Scale (mRS) and categorized as favorable outcome (mRS 0–2), severe disability (mRS 3–5), and death (mRS 6). Multivariable logistic regression analysis was performed to identify independent predictors of AF. Results: A total of 152 patients were included, with a mean age of 63.8 ± 5.86 years; 64.5% were male and 63.8% were older than 60 years. Atrial fibrillation was present in 34 patients (22.4%). AF was significantly associated with unfavorable outcomes at discharge (p < 0.001). In multivariable analysis, age ≤60 years was independently associated with a reduced likelihood of AF (adjusted OR 0.06, 95% CI: 0.01–0.43, p = 0.005), while other variables were not statistically significant. Conclusion: Atrial fibrillation is a common comorbidity in patients with acute ischemic stroke and is strongly associated with adverse in-hospital outcomes. Increasing age remains the most significant independent predictor of AF. Early identification and targeted management of AF, particularly in elderly patients, may improve clinical outcomes.