To estimate recent trends in atrial fibrillation (AF) among patients with ischemic stroke (IS) and seizure and ascertain the risk of seizure in hospitalized IS patients with AF.

Atrial fibrillation is a major precursor to stroke, and epilepsy is a key complication from stroke. In the context of stroke, both these conditions tend to occur more frequently with rising age, but despite the rapid aging of US population, there is no contemporary nationwide information about their occurrence and interaction among stroke patients.

Retrospective analysis using the National Inpatient Sample database (2006-2014). Adults (≥18 years) with a discharge diagnosis of IS identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 433.X1, 434.X1 and 436 formed our study sample. A subset of patients with seizure (ICD-9-CM 780.3x and 435.x) was selected. We compared the rate of AF (ICD-9-CM code 427.31) across pre-specified variables in patients with IS. We applied a multivariable logistic regression model to examine the independent association between seizure and AF in patients with IS. We also analyzed changes in the rate of AF across years in the subset of patients with a primary diagnosis of IS and comorbid seizure.

Overall, 1,031,643 (weighted 5,103,496) patients with a primary discharge diagnosis of IS were identified including 200,728 (19.5%) with AF and 49,556 (4.8%) with seizure. There was a 16% relative increase in the prevalence of AF between 2006/08 and 20012/14 among patients with IS and comorbid seizure. AF was associated with a 10% increased risk of seizure among patients with IS.

AF is frequent, has increased overtime in IS patients with comorbid seizure, and is independently associated with a 10% increased risk of seizure in hospitalized ischemic stroke patients. As the nation continues to age, more emphasis on AF and seizure treatment may improve stroke outcomes.