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Updated stroke guidelines revealed hidden PFOs and linked early detection to survival gains in younger adults. 

The study published in the June 2025 issue of Journal of Neurology about an updated European Stroke Organization guideline in 2018 that sustained rapid evaluation and closure of patent foramen ovale (PFO) in patients with ischemic stroke aged 60 years or younger to lower recurrence and mortality rates.  

Researchers conducted a retrospective study to analyze the effect of the 2018 guidelines on PFO detection and to compare recurrence and mortality risks based on PFO status.  

They used linked administrative health records in Catalonia to explore all patients with ischemic stroke aged 18–60 from 2016 to 2021, collecting information on PFO diagnosis, demographics, comorbidities, stroke recurrence, and mortality.  

The results showed that 13,780 individuals experienced ischemic stroke, with a crude annual incidence of 30.3 per 1,00,000 inhabitants/year. The PFO was identified in 749 patients (5.4%), who were generally younger and had fewer risk factors compared to non-PFO patients (all P value < 0.05). After adjusting for age and sex, PFO detection increased by 59% following the guideline update. The 5-year stroke recurrence rate was 12.1% [95% CI 11.3–12.9], with no variation by age or PFO status. Lower socioeconomic status and the presence of diabetes were associated with higher recurrence. Mortality was reduced in patients with stroke and PFO (P value = 0.016), and this reduction in 4-year mortality was significant only in patients aged ≤ 50 years.  

Investigators concluded that guideline updates led to increased PFO detection, while diabetes and socioeconomic status independently predicted stroke recurrence, and younger patients with PFO had reduced all-cause mortality. 

Source: link.springer.com/article/10.1007/s00415-025-13178-x