In the latest American Heart Association/American College of Cardiology/Heart Rhythm Society
atrial fibrillation (AF) guidelines, CHA2DS2-VASc replaced the CHADS2
stroke risk assessment to determine prophylactic anticoagulation, reflecting female gender's association with
stroke incidence in AF. However, little investigation has been pursued of potential risk factors associated with worsened
stroke severity. In this study, we examined patients with AF with
ischemic stroke patient characteristics associated with increased
stroke severity. Using the Get With The Guidelines-
Stroke database, we retrospectively identified 221 consecutive patients with AF diagnosed with
acute ischemic stroke and performed in depth chart review, evaluating demographics, labs, and co-morbidities. We analyzed the modified Rankin Scale (mRS) at discharge as a surrogate for
stroke severity, defining severe
stroke as fatal (mRS of 6) or disabling (mRS 4 to 5), requiring max assistance with ambulation or
activities of daily living. Female gender, advanced age, and decreased body surface area were associated with disabling or fatal
stroke (68.3% of patients with mRS 4 to 6 vs 50% with mRS 0 to 3, 78.4 vs 71.1 year, and 1.83 vs 1.92, respectively). Using a backward elimination approach revealed a logistic regression model with statistically significant odds ratios (
ORs) for female gender (OR 1.99) and age (OR 1.04), and borderline significant for a history of
coronary artery disease (OR 1.89). In conclusion, female gender is associated in the AF population with a twofold risk of severe disabling or fatal
ischemic stroke, a finding that persists after controlling for potential confounders. This finding highlights the potential benefit from appropriate anticoagulation use for
stroke prophylaxis in the AF population.