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OBJECTIVES Postoperative atrial fibrillation (POAF) is a common complication after coronary artery bypass grafting. Although transient, POAF is linked to increased late mortality. We hypothesized that POAF increases late cerebrovascular (CeV) and composite cerebrovascular/cardiovascular/vascular (CV* = CeV + CV + Other-V) but not non-cardiovascular (Non-CV) mortality. METHODS We analysed 8807 non-salvage coronary artery bypass grafting patients (1994–2011). Fifteen-year and time-segmented (early, 0–1 year; intermediate, 1–6 years and late, 6–15 years) all-cause and cause-specific mortality were compared for POAF versus No-POAF patients. Corresponding POAF versus No-POAF adjusted hazard ratios [AHRs (95% confidence interval, CI)] were derived using the competing risk Cox regression. RESULTS POAF occurred in 1992 (23%) patients. Complications other than POAF occurred in 1875 (21%) patients but were more frequent among POAF patients (31% vs 18%; P  < 0.001). Overall mean follow-up was 9 ± 4 years. POAF patients had a higher 15-year unadjusted mortality (53% vs 39%; P  < 0.001) and were consequently associated with higher adjusted all-cause [AHR (95% CI) = 1.23 (1.14–1.33)] and composite cardiovascular [CV*: AHR (95% CI) = 1.15 (1.02–1.30)] mortality. The trends towards a higher 15-year CeV [AHR (95% CI) = 1.34 (0.94–1.91)] and Non-CV [AHR (95% CI) = 1.12 (0.99–1.26)] mortality were not significant. Time-segmented analyses showed that (i) POAF increased all-cause mortality early, and this persisted in the intermediate and late periods and (ii) CeV [AHR (95% CI) = 2.14 (1.14–4.04)] and CV* [AHR (95% CI) = 1.31 (1.06–1.62)] mortality rates were increased in the intermediate but not in the early or late periods. Non-CV mortality was similar in POAF and No-POAF for all time intervals. These findings were corroborated in propensity-matched sub-cohorts and in sensitivity analyses in patients free of any other complication. CONCLUSIONS POAF is associated with worse long-term survival principally driven by increased intermediate-term cerebrovascular and cardiovascular mortality, while Non-CV mortality was similar. [ABSTRACT FROM AUTHOR]

Early neurological deterioration (END) in acute ischaemic stroke is a common event. The underlying mechanisms are heterogeneous. The clinical predictors of END include severity of the initial stroke, large vessel occlusion, diabetes mellitus, hypotension, and atrial fibrillation. Serial observations and detailed assessment by the trained staff in specialised stroke units are key to the successful management of these patients. Advances in brain and vascular imaging have provided insight into the underlying mechanisms, enabling clinicians to use preventative and therapeutic interventions specifically targeted at them, though several questions still remain unanswered. END has potentially serious consequences on the short term (morbidity and death) and long term (recovery from stroke) outcomes for the patient. Therefore, attempts to prevent and treat END should be made promptly and aggressively. [ABSTRACT FROM AUTHOR]

Objectives: non-valvular atrial fibrillation (NVAF) is an established risk factor for thromboembolism and stroke. Small cross-sectional studies suggest associations between NVAF, silent cerebral infarction and decreased cognitive function. We compared change in cognitive function between patients with recent onset NVAF and controls 12 and 36 months after baseline assessment, and examined the impact of anti-thrombotic therapy. Design: prospective longitudinal cohort study with follow-up at 12 and 36 months. Setting: Sunderland and South Tyneside, North East of England. Participants: community-dwelling men and women aged over 60 with recently identified NVAF or in sinus rhythm, matched for age, sex and general practice (N = 362, 174 NVAF, 188 sinus rhythm). Participants were stratified for use of anti-thrombotic therapy. Measurements: assessment included stroke risk factors and a comprehensive battery of neuropsychological tests. Results: at 3 years, 74 cases and 86 controls remained, giving an attrition rate for cases (59%) versus controls (52%);p = 0.15. Analysis of change in cognitive function between baseline and follow-up at 12 and 36 months revealed no clinically important differences between cases and controls, nor between subgroups on aspirin, warfarin or neither. Age and other confounders did not influence the results. Conclusions: there was no association between overall cognitive decline and NVAF after 3 years' follow-up, nor any apparent effect of anti-thrombotic therapy. This is consistent with our baseline results, but conflicts with previous studies. Cognitive decline is probably multifactorial and any influence of NVAF was not identified in this study. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editors discuss various reports within the issue on topics including a report on physicians' attitudes concerning anticoagulant treatment for atrial fibrillation (AF) patients, the reluctance of physicians to anticoagulate older patients, and the overestimation of bleeding risk by physicians which is a key barrier to oral anticoagulants (OAC) prescription.

The article discusses the stratification schemes of the risk factors of stroke in atrial fibrillation (AF) patients. It mentions that the need to categorize risks has fueled the development of the risk stratification systems based on stroke risk factors from non-warfarin arms of clinical trial cohorts. It also discusses the congestive heart failure, hypertension, diabetes mellitus and stroke or transient ischaemic attack (CHADS[2]) stratification scheme.

Discusses the baseline risk of stroke for individuals with atrial fibrillation. Features of the handheld computer-based system used for assessment to identify risk factors for stroke; Efficacy of warfarin and aspirin for preventing stroke in atrial fibrillation; Features of Stroke Prevention in Atrial Fibrillation Risk Calculator to assess risk factors.