Failure to expeditiously diagnose
atrial fibrillation (AF) as the cause of
ischemic stroke has unclear consequences. We studied the association between detection of AF after discharge and the risk of recurrent
stroke. We followed a prospectively assembled cohort of patients hospitalized for
stroke for 1 year for new diagnoses of AF and recurrent
stroke. We compared rates of recurrent
stroke in patients with a new diagnosis of AF and those without a new diagnosis of AF after discharge using Kaplan-Meier survival statistics. We conducted Cox proportional hazards analysis of the diagnosis and timing of AF and recurrent
stroke after adjustment for age, sex, race, preexisting AF,
hypertension,
dyslipidemia, diabetes, previous
stroke, and use of antithrombotic and
statin medications. Among 5575 patients with
stroke, 113 (2.0%) received a new diagnosis of AF after discharge, and 221 (4.0%) had recurrent
stroke. At 1 year, the Kaplan‒Meier rate of recurrent
stroke was 18.9% in those with a new diagnosis of AF and 4.5% in others, including those with AF diagnosed before or during the index hospitalization (P = .001). The association between a new diagnosis of AF and
stroke recurrence persisted after adjustment for potential confounders (hazard ratio, 5.6; 95% confidence interval, 3.4-9.1). A new diagnosis of AF after discharge for
stroke is associated with an increased risk of recurrent
stroke, even compared with patients with known AF. These findings identify a subset of patients at high risk for recurrent
stroke and highlight the importance of timely detection of AF in patients with
stroke.