Using the CHA2DS2-VASc score for refining stroke risk stratification in 'low-risk' Asian patients with Atrial fibrillation

Tze Fan Chao; Chia Jen Liu; Kang Ling Wang; Yenn Jiang Lin; Shih Lin Chang; Li Wei Lo; Yu Feng Hu; Ta Chuan Tuan; Tzeng Ji Chen; Gregory Y.H. Lip; Shih Ann Chen

doi:10.1016/j.jacc.2014.06.1203

Using the CHA₂DS₂-VASc score for refining stroke risk stratification in 'low-risk' Asian patients with Atrial fibrillation

Tze Fan Chao, Chia Jen Liu, Kang Ling Wang, Yenn Jiang Lin, Shih Lin Chang, Li Wei Lo, Yu Feng Hu, Ta Chuan Tuan, Tzeng Ji Chen, Gregory Y.H. Lip, Shih Ann Chen^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

158 Scopus citations

Abstract

Methods This study used the National Health Insurance research database in Taiwan. A total of 186,570 AF patients without antithrombotic therapy were selected as the study cohort. The clinical endpoint was the occurrence of ischemic stroke.

Background A new scoring system, the anticoagulation and risk factors in atrial fibrillation (ATRIA) score, was proposed for risk stratification in patients with atrial fibrillation (AF). Whether the ATRIA scheme can adequately identify patients who are at low risk of ischemic stroke remains unknown.

Objectives The goal of the present study was to compare the performance of ATRIA to that of CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65 to 74, female) scores for stroke prediction.

Results During the follow-up of 3.4 ±3.7 years, 23,723 patients (12.7%) experienced ischemic stroke. The CHA2DS2-VASc score performed better than ATRIA score in predicting ischemic stroke as assessed by c-indexes (0.698 vs. 0.627, respectively; p < 0.0001). The CHA2DS2-VASc score also improved the net reclassification index by 11.7% compared with ATRIA score (p < 0.0001). Among 73,242 patients categorized as low-risk on the basis of an ATRIA score of 0 to 5, the CHA2DS2-VASc scores ranged from 0 to 7, and annual stroke rates ranged from 1.06% to 13.33% at 1-year follow-up and from 1.15% to 8.00% at 15-year follow-up. The c-index of CHA2DS2-VASc score (0.629) was significantly higher than that of the ATRIA score (0.593) in this low-risk category (p < 0.0001).

Conclusions Patients categorized as low-risk by use of the ATRIA score were not necessarily low-risk, and the annual stroke rates can be as high as 2.95% at 1-year follow-up and 2.84% at 15-year follow-up. In contrast, patients with a CHA2DS2-VASc score of 0 had a truly low risk of ischemic stroke, with an annual stroke rate of approximately 1%. (J Am Coll Cardiol 2014;64:165865).

Original language	English
Pages (from-to)	1658-1665
Number of pages	8
Journal	Journal of the American College of Cardiology
Volume	64
Issue number	16
DOIs	https://doi.org/10.1016/j.jacc.2014.06.1203
State	Published - 21 Oct 2014

Keywords

ATRIA score
CHADS-VASc score
atrial fibrillation
ischemic stroke

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10.1016/j.jacc.2014.06.1203

Cite this

Chao, T. F., Liu, C. J., Wang, K. L., Lin, Y. J., Chang, S. L., Lo, L. W., Hu, Y. F., Tuan, T. C., Chen, T. J., Lip, G. Y. H., & Chen, S. A. (2014). Using the CHA₂DS₂-VASc score for refining stroke risk stratification in 'low-risk' Asian patients with Atrial fibrillation. Journal of the American College of Cardiology, 64(16), 1658-1665. https://doi.org/10.1016/j.jacc.2014.06.1203

@article{95c328ee733d48819ec1ef1a983946f8,

title = "Using the CHA2DS2-VASc score for refining stroke risk stratification in 'low-risk' Asian patients with Atrial fibrillation",

abstract = "Methods This study used the National Health Insurance research database in Taiwan. A total of 186,570 AF patients without antithrombotic therapy were selected as the study cohort. The clinical endpoint was the occurrence of ischemic stroke.Background A new scoring system, the anticoagulation and risk factors in atrial fibrillation (ATRIA) score, was proposed for risk stratification in patients with atrial fibrillation (AF). Whether the ATRIA scheme can adequately identify patients who are at low risk of ischemic stroke remains unknown.Objectives The goal of the present study was to compare the performance of ATRIA to that of CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65 to 74, female) scores for stroke prediction.Results During the follow-up of 3.4 ±3.7 years, 23,723 patients (12.7%) experienced ischemic stroke. The CHA2DS2-VASc score performed better than ATRIA score in predicting ischemic stroke as assessed by c-indexes (0.698 vs. 0.627, respectively; p < 0.0001). The CHA2DS2-VASc score also improved the net reclassification index by 11.7% compared with ATRIA score (p < 0.0001). Among 73,242 patients categorized as low-risk on the basis of an ATRIA score of 0 to 5, the CHA2DS2-VASc scores ranged from 0 to 7, and annual stroke rates ranged from 1.06% to 13.33% at 1-year follow-up and from 1.15% to 8.00% at 15-year follow-up. The c-index of CHA2DS2-VASc score (0.629) was significantly higher than that of the ATRIA score (0.593) in this low-risk category (p < 0.0001).Conclusions Patients categorized as low-risk by use of the ATRIA score were not necessarily low-risk, and the annual stroke rates can be as high as 2.95% at 1-year follow-up and 2.84% at 15-year follow-up. In contrast, patients with a CHA2DS2-VASc score of 0 had a truly low risk of ischemic stroke, with an annual stroke rate of approximately 1%. (J Am Coll Cardiol 2014;64:165865).",

keywords = "ATRIA score, CHADS-VASc score, atrial fibrillation, ischemic stroke",

author = "Chao, {Tze Fan} and Liu, {Chia Jen} and Wang, {Kang Ling} and Lin, {Yenn Jiang} and Chang, {Shih Lin} and Lo, {Li Wei} and Hu, {Yu Feng} and Tuan, {Ta Chuan} and Chen, {Tzeng Ji} and Lip, {Gregory Y.H.} and Chen, {Shih Ann}",

note = "Publisher Copyright: {\textcopyright} 2014 American College of Cardiology Foundation.",

year = "2014",

month = oct,

day = "21",

doi = "10.1016/j.jacc.2014.06.1203",

language = "English",

volume = "64",

pages = "1658--1665",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier USA",

number = "16",

}

TY - JOUR

T1 - Using the CHA2DS2-VASc score for refining stroke risk stratification in 'low-risk' Asian patients with Atrial fibrillation

AU - Chao, Tze Fan

AU - Liu, Chia Jen

AU - Wang, Kang Ling

AU - Lin, Yenn Jiang

AU - Chang, Shih Lin

AU - Lo, Li Wei

AU - Hu, Yu Feng

AU - Tuan, Ta Chuan

AU - Chen, Tzeng Ji

AU - Lip, Gregory Y.H.

AU - Chen, Shih Ann

PY - 2014/10/21

Y1 - 2014/10/21

N2 - Methods This study used the National Health Insurance research database in Taiwan. A total of 186,570 AF patients without antithrombotic therapy were selected as the study cohort. The clinical endpoint was the occurrence of ischemic stroke.Background A new scoring system, the anticoagulation and risk factors in atrial fibrillation (ATRIA) score, was proposed for risk stratification in patients with atrial fibrillation (AF). Whether the ATRIA scheme can adequately identify patients who are at low risk of ischemic stroke remains unknown.Objectives The goal of the present study was to compare the performance of ATRIA to that of CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65 to 74, female) scores for stroke prediction.Results During the follow-up of 3.4 ±3.7 years, 23,723 patients (12.7%) experienced ischemic stroke. The CHA2DS2-VASc score performed better than ATRIA score in predicting ischemic stroke as assessed by c-indexes (0.698 vs. 0.627, respectively; p < 0.0001). The CHA2DS2-VASc score also improved the net reclassification index by 11.7% compared with ATRIA score (p < 0.0001). Among 73,242 patients categorized as low-risk on the basis of an ATRIA score of 0 to 5, the CHA2DS2-VASc scores ranged from 0 to 7, and annual stroke rates ranged from 1.06% to 13.33% at 1-year follow-up and from 1.15% to 8.00% at 15-year follow-up. The c-index of CHA2DS2-VASc score (0.629) was significantly higher than that of the ATRIA score (0.593) in this low-risk category (p < 0.0001).Conclusions Patients categorized as low-risk by use of the ATRIA score were not necessarily low-risk, and the annual stroke rates can be as high as 2.95% at 1-year follow-up and 2.84% at 15-year follow-up. In contrast, patients with a CHA2DS2-VASc score of 0 had a truly low risk of ischemic stroke, with an annual stroke rate of approximately 1%. (J Am Coll Cardiol 2014;64:165865).

AB - Methods This study used the National Health Insurance research database in Taiwan. A total of 186,570 AF patients without antithrombotic therapy were selected as the study cohort. The clinical endpoint was the occurrence of ischemic stroke.Background A new scoring system, the anticoagulation and risk factors in atrial fibrillation (ATRIA) score, was proposed for risk stratification in patients with atrial fibrillation (AF). Whether the ATRIA scheme can adequately identify patients who are at low risk of ischemic stroke remains unknown.Objectives The goal of the present study was to compare the performance of ATRIA to that of CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65 to 74, female) scores for stroke prediction.Results During the follow-up of 3.4 ±3.7 years, 23,723 patients (12.7%) experienced ischemic stroke. The CHA2DS2-VASc score performed better than ATRIA score in predicting ischemic stroke as assessed by c-indexes (0.698 vs. 0.627, respectively; p < 0.0001). The CHA2DS2-VASc score also improved the net reclassification index by 11.7% compared with ATRIA score (p < 0.0001). Among 73,242 patients categorized as low-risk on the basis of an ATRIA score of 0 to 5, the CHA2DS2-VASc scores ranged from 0 to 7, and annual stroke rates ranged from 1.06% to 13.33% at 1-year follow-up and from 1.15% to 8.00% at 15-year follow-up. The c-index of CHA2DS2-VASc score (0.629) was significantly higher than that of the ATRIA score (0.593) in this low-risk category (p < 0.0001).Conclusions Patients categorized as low-risk by use of the ATRIA score were not necessarily low-risk, and the annual stroke rates can be as high as 2.95% at 1-year follow-up and 2.84% at 15-year follow-up. In contrast, patients with a CHA2DS2-VASc score of 0 had a truly low risk of ischemic stroke, with an annual stroke rate of approximately 1%. (J Am Coll Cardiol 2014;64:165865).

KW - ATRIA score

KW - CHADS-VASc score

KW - atrial fibrillation

KW - ischemic stroke

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U2 - 10.1016/j.jacc.2014.06.1203

DO - 10.1016/j.jacc.2014.06.1203

M3 - Article

C2 - 25323252

AN - SCOPUS:84907969698

SN - 0735-1097

VL - 64

SP - 1658

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JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

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ER -