TITLE:
When Morbidity Intersects: Ischemic Stroke Related to Atrial Fibrillation in the Geriatric Population
AUTHORS:
Fatimazahra Ait Fatah, Hajar Khattab, Asmaa Sikkal, Kamal Haddou Ali, Salma Bellakhdar, Hicham El Otmani, Bouchra El Moutawakil, Mohammed Abdoh Rafai
KEYWORDS:
Ischemic Stroke, Atrial Fibrillation, Elderly, Frailty, Atrial Cardiomyopathy, Prognosis
JOURNAL NAME:
Neuroscience and Medicine,
Vol.17 No.1,
March
10,
2026
ABSTRACT: Background: Ischemic stroke (IS) remains one of the leading causes of disability and mortality worldwide. Atrial fibrillation (AF) is a major cardioembolic risk factor, particularly in older adults, in whom stroke often occurs on a background of frailty and multiple comorbidities. However, data focusing on the specific clinical and prognostic features of AF-related ischemic stroke in geriatric populations remains limited. Objective: To describe the clinical, radiological, and functional characteristics of ischemic stroke related to atrial fibrillation in patients aged 65 years and older, and to compare outcomes between patients with and without atrial cardiomyopathy. Methods: We conducted a retrospective observational study in the Neurology Department of CHU Ibn Rochd (Casablanca, Morocco) between January 2024 and June 2025. Patients aged ≥ 65 years with confirmed cardioembolic ischemic stroke due to AF were included. Patients were classified according to comorbidities (isolated AF, AF + hypertension, AF + hypertension + structural heart disease) and according to the presence of atrial cardiomyopathy (left atrial dilation and/or fibrosis). Clinical severity (NIHSS), nutritional status (MNA), frailty (Clinical Frailty Scale), functional autonomy (Katz ADL), and disability (modified Rankin Scale, mRS) were analyzed. Statistical analysis used Chi-square and ANOVA tests. Results: A total of 250 patients were included (mean NIHSS: 13.5). Stroke severity increased significantly with age and number of comorbidities. Atrial cardiomyopathy was present in 32% of patients and was associated with higher NIHSS scores (15 vs 12), more extensive ischemic lesions on imaging, and increased mortality. At 3 months, patients with atrial cardiomyopathy had worse functional outcomes (mean mRS 4.1 vs 3.2). Persistent dependency was observed in 59% of cases, and malnutrition affected 68% of patients. Conclusion: In elderly patients, ischemic stroke related to atrial fibrillation is strongly influenced by frailty and comorbidities. Atrial cardiomyopathy emerges as a key marker of severity and poor prognosis. Its identification may help refine risk stratification and optimize management strategies in this vulnerable population.