1. VBWG In-hospital course of stroke patients with vs without AF Steger C et al. Eur Heart J. 2004;6:in press. More severe stroke on admission Lower Barthel Index Higher proportion with Rankin Scale score (%) Higher rate of medical complications Pneumonia (%) Pulmonary edema (%) Symptomatic intracerebral hemorrhage (%) Mortality (%) Poorer neurological status at discharge Lower Barthel Index Higher Rankin Scale score P < 0.0004 for all comparisons With AFWithout AF 15 52 40 31 23 12 8 25 9 6 2 14 60 4 85 2

2. VBWG Detection of AF after acute stroke/TIA Jabaudon D et al. Stroke. 2004;35:1647-51.ELR = 2-lead event-loop recording device N = 149Stroke/TIA ECG No Yes 4 (2.7%) 6 (4.1%) 7 (4.9%) 5 (5.7%) n = 88/132 7-day ELR n = 145 Additional ECG n = 13924-hr Holter No Yes AF? No. AF detected Yes AF? No AF?

3. VBWG Risk of AF by duration of heart rhythm Jabaudon D et al. Stroke. 2004;35:1647-51. Monitoring time (hours) AF risk (%) ECG HolterELR

4. VBWG Recurrence of AF 13 months post-stroke/TIA Jabaudon D et al. Stroke. 2004;35:1647-51.ELR = 2-lead event-loop recording device 0 10 20 30 40 50 60 ECG or 24-hr Holter7-day ELR AF recurrence (%)

5. VBWG Clinical challenge: Addressing the rising burden of AF and stroke Lloyd-Jones DM et al. Circulation. 2004;110:1042-6. AHA. Heart Disease and Stroke Statistics—2004 Update. Jabaudon D et al. Stroke. 2004;35:1647-51. AF continues to present an enormous public health problem – Men and women >40 yrs have lifetime risk for AF of ~1 in 4 – Estimated 2.2 million Americans – May account for up to 140,000 strokes yearly ECG and 24-hr Holter monitoring do not identify all stroke/TIA patients with AF Many AF patients are not receiving anticoagulant therapy to prevent recurrent stroke

6. VBWG Role of anticoagulant therapy in secondary prevention of stroke AF should be strongly suspected in all patients with acute stroke/TIA or TIA – All stroke/TIA patients with confirmed AF should receive anticoagulant therapy Warfarin – Pro: Proven effective – Con: Need for frequent (and costly) monitoring and dose adjustment New anticoagulants that offer fixed dosing with no monitoring are under investigation and may address warfarin’s shortcomings – Oral (direct thrombin inhibitors, ie, ximelagatran) – Parenteral (low–molecular-weight heparins, factor Xa inhibitors)