CHA2DS2-VASc score and prognosis in ischemic strokes with atrial fibrillation

Abstract

The CHA(2)DS(2)-VASc score was developed to improve stroke risk stratification in atrial fibrillation (AF) patients. We sought to analyze the distribution and prognostic value of the CHA(2)DS(2)-VASc score in a cohort of ischemic stroke patients with AF. In total, 439 consecutive stroke patients with AF were studied. The CHA(2)DS(2)-VASc score was calculated according to clinical status before stroke onset. Poor outcome was defined as a modified Rankin score of 3 to 6 at 3 months. Association between CHA(2)DS(2)-VASc score and poor outcome was analyzed using logistic regression analysis. In 95.6% of patients, CHA(2)DS(2)-VASc was >1 and only 41.8% of those with previously diagnosed AF were using oral anticoagulation at the time of the stroke. Poor outcome was found in 53.1% of the patients. In univariate analysis age, female sex, current smoking, previous stroke, CHA(2)DS(2)-VASc score, and stroke severity were associated with outcome. In multivariate analysis, CHA(2)DS(2)-VASc score was independently associated with poor outcome [OR 1.36 (95% CI: 1.14-1.62), P = 0.001] as well as NIHSS [OR 1.22 (95% CI: 1.17-1.26), P < 0.001]. After removing stroke severity, therapeutic anticoagulation was also associated with stroke prognosis [OR 0.45 (95% CI: 0.23-0.86), P = 0.016]. Most patients with ischemic stroke and AF have a high CHA(2)DS(2)-VASc score. Independent of stroke severity, CHA(2)DS(2)-VASc score is associated with 3-month outcome. Despite all the available information and guidelines, our AF patients are clearly undertreated.

Associations between Pre-Admission Risk Scores and Two-Year Clinical Outcomes in Ischemic Stroke or Transient Ischemic Attack Patients with Non-Valvular Atrial Fibrillation

“…These risk stratification schemes may also be useful for predicting clinical outcomes in ischemic stroke or transient ischemic attack (TIA) patients with AF. In fact, we [4, 5] and others [6-9] have reported positive associations between pre-admission CHADS 2 and CHA 2 DS 2 -VASc scores and poor clinical outcomes in ischemic stroke patients with AF. In these studies, however, clinical outcomes were assessed at ≤3 months.…”

CHADS₂, CHA₂DS₂-VASc, and R₂CHADS₂ Scores Are Associated With 3-Month Functional Outcome of Stroke in Patients With Prior Coronary Artery Disease

“…Giralt-Steinhauer et al enrolled 439 stroke patients with AF and reported that a higher CHA2DS2-VASc score was associated with poor 3-month functional outcome (OR, 1.36; P=0.001). 26 In contrast, Tu et al found that low prestroke CHA2DS2-VASc score had high specificity for good functional outcome within 3 months following stroke in patients with or without AF. 27 …”

Prestroke CHA2DS2-VASc Score and Severity of Acute Stroke in Patients with Atrial Fibrillation: Findings from RAF Study

“…Whereas, several past studies were retrospective and used only a single assessment score [2][3][4][12][13][14] .…”

“…In retrospective studies CHA2DS2-VASc score have been suggested as a predictor of severity of stroke at admission and poor outcome [2][3][4] .…”