Background and Aims: Atrial fibrillation (AF) is a major risk factor for stroke. We investigated the short- and long- term prognosis of patients with a first-ever ischemic stroke (FEIS) and AF.
Methods: Prospective population-based registry including all the residents with a FEIS in 2011-2013 followed up to August 2018.
Results: During the study period we identified 1023 patients with FEIS. After the exclusion of 104 nonresident patients and of 9 patients without ECG evaluation, AF was documented in 294 (32.3%; mean age 82.1±8.1 years) of the remaining 910 patients. One hundred eighty-eight patients (63.9%) with AF were women.
The 30-day, 1-year, and 5-year cumulative survival probability was lower in patients with AF than in those without the arrhythmia (P<0.001 at any time points). At 30 days cerebral and cardiac death were the most common causes in patients with and without  AF; from day 31 onward and up to 5 years we observed in both groups a progressive reduction of cerebral deaths and an increase of cardiac deaths. The Cox analysis, including age, sex, and vascular risk factors showed that AF at 30 days (HR 1.45, 95%CI 1.04-2.01) and at 1 year (HR 1.35, 95%CI 1.04-1.74) and diabetes mellitus at 30 days (HR 1.72, 95%CI 1.23-2.39) and at 1 year (HR 1.60, 95%CI 1.25-2.13) were independent predictors of short-term mortality; diabetes mellitus was also a 5-year predictor of mortality (HR 1.37, 95%CI 1.10-1.72).
Conclusions: Patients with FEIS and AF had the worst short-term prognosis underlining the need for closer monitoring of heart disease in both patients with and without AF in order to improve their long-term prognosis.

SHORT- AND LONG-TERM PROGNOSIS OF FIRST-EVER ISCHEMIC STROKE IN PATIENTS WITH ATRIAL FIBRILLATION