Atrial Fibrillation and Cardio-Embolic Stroke Affect Post-Stroke Delirium Risk

More experienced neurologists can slightly improve stroke outcomes.
More experienced neurologists can slightly improve stroke outcomes.
Researchers sought to identify the relationship among atrial fibrillation, cardio-embolic stroke, and risk for post-stroke delirium.

Atrial fibrillation (AF) and cardio-embolic stroke may contribute to an increased risk for post-stroke delirium, according to study findings published in World Neurosurgery.

Investigators in China sought to determine if an association exists between AF and cardio-embolic stroke and post-stroke delirium. They conducted a systematic review and meta-analysis that included 18 observational studies published in English pooled from the Web of Science, Google Scholar, and PubMed databases from 1991 to 2021. Inclusion criteria included original data from peer-reviewed observational studies, data sufficient for calculating 95% confidence intervals and odds ratios, and full texts evaluating the relationships between cardio-embolic stroke and/or AF and post-stroke delirium.

These studies included 6291 patients with history of stroke, and study sizes varied from 60 to 1072 patients. Of the studies that included AF, 10 focused on White patients, 2 on Asian patients, and 2 on patients that were identified as other. Of the studies that included cardio-embolic stroke, 3 focused on Asian patients and 4 on patients that were identified as other. Investigators noted the Newcastle-Ottawa Scale assessing quality of nonrandomized studies in meta-analyses ranged from 6 to 9, suggesting relatively high quality.

They used Stata version 12.0 to perform the analysis. Heterogeneity among studies was determined by chi-square test-based I2 where I2 was greater or equal to 50%. This indicated significant heterogeneity between studies. When heterogeneity was present, a random-effects model was used. In the absence of heterogeneity, the fixed-effects model was used. Stability of pooled estimates was determined by sensitivity analysis. Publication bias was estimated with visual funnel plots or quantitative analyses based on Begg’s test.

Investigators found that AF was associated with increased risk for post-stroke delirium (odds ratio [OR], 2.30; 95% CI, 2.00-2.65; P <.0001). Compared with other types of stroke, cardio-embolic stroke had a greater risk for post-stroke delirium based on the TOAST classification (OR, 2.02; 95% CI, 1.47-2.79; P <.0001).

Review and meta-analysis limitations include the difference in ethnic populations between studies may affect the relationship between AF and cardio-embolic stroke with post-stroke delirium. Also, subgroup analysis was not conducted based on the screening tools and study design. With only 5 studies focused on the association between cardio-embolic stroke and post-stroke delirium, their potential publication bias may have been undetected by Begg’s test.

“Our meta-analysis suggested that AF and CES [cardio-embolic stroke] contribute to increase the risk of delirium after strokes,” the study authors wrote.  “Additionally, the exact physiopathologic mechanism that is responsible for this association should be further investigated.”


Xiong X, Fan M, Ma J, Deng J. Association of atrial fibrillation and cardio-embolic stroke with post-stroke delirium susceptibility: a systematic review and meta-analysis of observational studies. World Neurosurg. Published online August 12, 2022. doi:10.1016/j.wneu.2022.08.025

This article originally appeared on The Cardiology Advisor