Abstract 4145048: PAROXYSMAL ATRIAL FIBRILLATION PATIENTS ON ANTICOAGULATION PRESENTING WITH EMBOLIC STROKE: A NATIONWIDE ANALYSIS

Introduction/ Background: Paroxysmal Atrial Fibrillation is a clinical condition that increases the risk for embolic stroke. Current guidelines suggest anticoagulating patients with atrial fibrillation when the chadvasc score is > 2 to decrease the risk of embolic stroke. Aim/ Research Questions: Analyze comorbid conditions that holds significant associations with occurence of embolic stroke in paroxsymal atrial fibrillation admissions while being on long term anticoagulation. Methods/Approach: We used National inpatient Sample (2019) to identify admissions for embolic pattern stroke, with documented history of Paroxysmal Atrial Fibrillation (p AFib) on chronic anticoagulation (AC) (Age group > 18 years).Prevalence of comorbid conditions in the cohort was analyzed. Associations of the comorbid conditions with occurrence of embolic stroke in the admission cohort was analyzed using multivariate linear regression. A two tailed p value < 0.05 was used to define significance in all the calculations. Results/Data: (descriptive and inferential statistics) Of 4780 admissions for embolic stroke with comorbid Pafib on chronic AC were identified. Mean age of the admission cohort was 76.94. Of the admissions, 38.192% had congestive heart failure, 25.83% had chronic kidney disease, 41.94% had uncontrolled hypertension, 54.18% had diagnosis of unspecified hyperlipidemia, 0.523% had Hypertrophic obstructive cardiomyopathy, 0.73% had rheumatic/non rheumatic mitral stenosis listed as their comorbidities. Statistically significant association was seen between uncontrolled hypertension and occurence of embolic stroke OR: 1.997. 95%: 1.756- 2.27. Documented diagnosis of unspecified hyperlipidemia had statistically significant association with admissions for embolic stroke in the patient cohort: OR: 1.642, 95% CI: 1.214 – 1.845). Presence of coexisting HOCM and Mitral stenosis had positive ODDs but did not reach statistical significance {HOCM: OR :1.50, 95% :0.062 - 3.63 and Mitral stenosis: OR: 1.59, 95%: 0.075- 3.36). (Table 1) There was no statistically significant association between CHF, CKD, smoking or with presence of prosthetic valve with embolic stroke. (HOCM: hypertrophic obstructive cardiomyopathy) (OR: Odds Ratio) Conclusion(s): Based on our analysis, presence of uncontrolled hypertension and hyperlipidemia had significant association with the occurrence of embolic stroke in paroxysmal atrial fibrillation population who were on long term anticoagulation.