TY - JOUR
T1 - Detection of Atrial Fibrillation after Central Retinal Artery Occlusion
AU - MacGrory, Brian
AU - Landman, Sean R.
AU - Ziegler, Paul D.
AU - Boisvert, Chantal J.
AU - Flood, Shane P.
AU - Stretz, Christoph
AU - Madsen, Tracy E.
AU - Reznik, Michael E.
AU - Cutting, Shawna
AU - Moore, Elizabeth E.
AU - Hewitt, Hunter
AU - Closser, James B.
AU - Torres, Jose
AU - Lavin, Patrick J.
AU - Furie, Karen L.
AU - Xian, Ying
AU - Feng, Wayne
AU - Biousse, Valérie
AU - Schrag, Matthew
AU - Yaghi, Shadi
N1 - Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - Background: Central retinal artery occlusion (CRAO) causes sudden, irreversible blindness and is a form of acute ischemic stroke. In this study, we sought to determine the proportion of patients in whom atrial fibrillation (AF) is detected by extended cardiac monitoring after CRAO. Methods: We performed a retrospective, observational cohort study using data from the Optum deidentified electronic health record of 30.8 million people cross-referenced with the Medtronic CareLink database of 2.7 million people with cardiac monitoring devices in situ. We enrolled patients in 3 groups: (1) CRAO, (2) cerebral ischemic stroke, and (3) age-, sex-, and comorbidity-matched controls. The primary end point was the detection of new AF (defined as ≥2 minutes of AF detected on a cardiac monitoring device). Results: We reviewed 884 431 patient records in common between the two databases to identify 100 patients with CRAO, 6559 with ischemic stroke, and 1000 matched controls. After CRAO, the cumulative incidence of new AF at 2 years was 49.6% (95% CI, 37.4%-61.7%). Patients with CRAO had a higher rate of AF than controls (hazard ratio, 1.64 [95% CI, 1.17-2.31]) and a comparable rate to patients with stroke (hazard ratio, 1.01 [95% CI, 0.75-1.36]). CRAO was associated with a higher incidence of new stroke compared with matched controls (hazard ratio, 2.85 [95% CI, 1.29-6.29]). Conclusions: The rate of AF detection after CRAO is higher than that seen in age-, sex-, and comorbidity-matched controls and comparable to that seen after ischemic cerebral stroke. Paroxysmal AF should be considered as part of the differential etiology of CRAO, and those patients may benefit from long-term cardiac monitoring.
AB - Background: Central retinal artery occlusion (CRAO) causes sudden, irreversible blindness and is a form of acute ischemic stroke. In this study, we sought to determine the proportion of patients in whom atrial fibrillation (AF) is detected by extended cardiac monitoring after CRAO. Methods: We performed a retrospective, observational cohort study using data from the Optum deidentified electronic health record of 30.8 million people cross-referenced with the Medtronic CareLink database of 2.7 million people with cardiac monitoring devices in situ. We enrolled patients in 3 groups: (1) CRAO, (2) cerebral ischemic stroke, and (3) age-, sex-, and comorbidity-matched controls. The primary end point was the detection of new AF (defined as ≥2 minutes of AF detected on a cardiac monitoring device). Results: We reviewed 884 431 patient records in common between the two databases to identify 100 patients with CRAO, 6559 with ischemic stroke, and 1000 matched controls. After CRAO, the cumulative incidence of new AF at 2 years was 49.6% (95% CI, 37.4%-61.7%). Patients with CRAO had a higher rate of AF than controls (hazard ratio, 1.64 [95% CI, 1.17-2.31]) and a comparable rate to patients with stroke (hazard ratio, 1.01 [95% CI, 0.75-1.36]). CRAO was associated with a higher incidence of new stroke compared with matched controls (hazard ratio, 2.85 [95% CI, 1.29-6.29]). Conclusions: The rate of AF detection after CRAO is higher than that seen in age-, sex-, and comorbidity-matched controls and comparable to that seen after ischemic cerebral stroke. Paroxysmal AF should be considered as part of the differential etiology of CRAO, and those patients may benefit from long-term cardiac monitoring.
KW - arrhythmias, cardiac
KW - atrial fibrillation
KW - comorbidity
KW - incidence
KW - ischemic stroke
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UR - http://www.scopus.com/inward/citedby.url?scp=85109703231&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.120.033934
DO - 10.1161/STROKEAHA.120.033934
M3 - Article
C2 - 34092124
AN - SCOPUS:85109703231
SN - 0039-2499
VL - 52
SP - 2773
EP - 2781
JO - Stroke
JF - Stroke
IS - 9
ER -