Atrial Fibrillation and Acute Ischemic Stroke: Evaluation of the Contemporary 2018 National Inpatient Sample Database

Background

Atrial fibrillation (AF) in acute ischemic stroke (AIS) is considered a binary entity regardless of AF type. We aim to investigate in-hospital morbidity and mortality among patients with nonparoxysmal AF–related AIS.

Methods

Patients hospitalized for AIS with associated paroxysmal or persistent AF were identified from the 2018 national inpatient sample database. We compared in-hospital mortality, stroke-related morbidity, hospital cost, length of stay, and discharge disposition in patients hospitalized with paroxysmal or persistent AF.

Results

A total of 26,470 patients were hospitalized for AIS with paroxysmal or persistent AF. Patient with AIS with persistent AF had a longer hospital length of stay (paroxysmal AF, mean [M] 5.7 days, standard deviation [SD] ±6.8 days; persistent AF, M 7.4 days, SD ±11.9 days, P < 0.001) and in-hospital costs (paroxysmal AF, M $15,449, SD ±$18,320; persistent AF, M $19,834 SD ±$23,312, P < 0.001). Patients with AIS with permanent AF had higher in-hospital mortality (paroxysmal AF, 4.6%, vs permanent AF, 6.2%, P < 0.001). Indirect markers of stroke-related disability, like intracranial hemorrhage (odds ratio [OR]: 1.9, 95% confidence interval (CI): 1.6-2.2), need for gastrostomy (OR: 2.1, 95% CI: 1.8-2.4), and tracheostomy (OR: 3.1, 95% CI: 2.1-4.4) were more associated with AIS from persistent AF.

Conclusions

Persistent AF is associated with poor in-hospital stroke-related outcome, possibly due to a worse thrombo-embolic phenomenon. AF pattern may be a harbinger of worse stroke-related morbidity.

Isolation of human T-cell leukemia virus in acquired immune deficiency syndrome (AIDS)

Several isolates of a human type-C retrovirus belonging to one group, known as human T-cell leukemia virus (HTLV), have previously been obtained from patients with adult T-cell leukemia or lymphoma. The T-cell tropism of HTLV and its prevalence in the Caribbean basin prompted a search for it in patients with the epidemic T-cell immune deficiency disorder known as AIDS. Peripheral blood lymphocytes from one patient in the United States and two in France were cultured with T-cell growth factor (TCGF) an shown to express HTLV antigens. Virus from the U.S. patient was isolated and characterized and shown to be related to HTLV subgroup I. The virus was also transmitted into normal human T cells from umbilical cord blood of a newborn. Whether or not HTLV-I or other retroviruses of this family with T-cell tropism cause AIDS, it is possible that patients from whom the virus can be isolated can also transmit it to others. If the target cell of AIDS is the mature T cell as suspected, the methods used in these studies may prove useful for the long-term growth of these cells and for the identification of antigens specific for the etiological agent of AIDS.