Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: nationwide cohort study

By J. Olesen, G. Lip, M. L. Hansen, P. Hansen, J. Tolstrup, J. Lindhardsen, C. Selmer, Ole Ahlehoff, A. Olsen, G. Gislason and 1 more. British medical journal, 2011

1,437 citations recorded by the source corpus.

Objectives To evaluate the individual risk factors composing the CHADS2 (Congestive heart failure, Hypertension, Age≥75 years, Diabetes, previous Stroke) score and the CHA2DS2-VASc (CHA2DS2-Vascular disease, Age 65-74 years, Sex category) score and to calculate the capability of the schemes to predict thromboembolism. Design Registry based cohort study. Setting Nationwide data on patients admitted to hospital with atrial fibrillation. Population All patients with atrial fibrillation not treated with vitamin K antagonists in Denmark in the period 1997-2006. Main outcome measures Stroke and thromboembolism. Results Of 121 280 patients with non-valvular atrial fibrillation, 73 538 (60.6%) fulfilled the study inclusion criteria. In patients at “low risk” (score=0), the rate of thromboembolism per 100 person years was 1.67 (95% confidence interval 1.47 to 1.89) with CHADS2 and 0.78 (0.58 to 1.04) with CHA2DS2-VASc at one year’s follow-up. In patients at “intermediate risk” (score=1), this rate was 4.75 (4.45 to 5.07) with CHADS2 and 2.01 (1.70 to 2.36) with CHA2DS2-VASc. The rate of thromboembolism depended on the individual risk factors composing the scores, and both schemes underestimated the risk associated with previous thromboembolic events. When patients were categorised into low, intermediate, and high risk groups, C statistics at 10 years’ follow-up were 0.812 (0.796 to 0.827) with CHADS2 and 0.888 (0.875 to 0.900) with CHA2DS2-VASc. Conclusions The risk associated with a specific risk stratification score depended on the risk factors composing the score. CHA2DS2-VASc performed better than CHADS2 in predicting patients at high risk, and those categorised as low risk by CHA2DS2-VASc were truly at low risk for thromboembolism.

Subfields: Cardiology and Cardiovascular Medicine, Epidemiology, Internal Medicine

View Paper: https://www.semanticscholar.org/paper/cdafed5b2ba126e83d2a84c2e6fad809e952aafe

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Citations in the corpus

2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. (2017, background): “On the basis of these findings, the writing group supports the use of anticoagulation in patients with AF when their CHA2DS2-VASc score is 2 or greater.”
Guidelines for the Prevention of Stroke in Women: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association (2014, background): “risk factors included in CHA 2 DS 2 -VASc.(389) The authors found”
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. (2016, neutral): “– 375 The rates of stroke and thrombo-embolism vary considerably in patients with CHA2DS2VASc scores of 1 or 2 due to differences in outcomes, populations, and anticoagulation status (Web Table 1).(371,376,377,1041) We therefore commissioned an analysis of stroke risk in men and women”
2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. (2017, background): “Many patients with VHD have AF, yet these patients were not included in the origi nal studies evaluating the risk of stroke or in the development of the ris k schema such as CHADS 2 or CHA2DS2-VASc (39,40).”
Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report (2012, neutral): “…on VKA, n Age, years Mean follow-up Major bleeding, per year EURO HEART SURVEY (2010)116 2115 66.8 1 y 1.5% ATRIA (2011)117 9186 71 3.5 y 1.4% Olesen et al. (2011)118 37425 70.6 10 y 4.62% Gallego et al. (2012)119 965 76 861 d 3.6% Donze et al. (2012)120 515 71.2 1 y 6.8% Friberg et al.…”
2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation--developed with the special contribution of the European Heart Rhythm Association. (2012, methodology): “32– 34 The risk of stroke also increases from age ≥65 years, with even greater risk at age 75 years or older.(32,35,36) Recommendation for screening of AF”
Stroke and bleeding in atrial fibrillation with chronic kidney disease. (2012, neutral): “7%.(4) vasodilators, beta blockers, calcium channel blockers, and renin-angiotensin system inhibitors.”