Prevalence of Atrial Fibrillation in Patients with High CHADS₂‐ and CHA₂DS₂VAS_c‐Scores: Anticoagulate or Monitor High‐Risk Patients?

Abstract

BackgroundIn patients with known atrial fibrillation (AF) different scores are utilized to estimate the risk of thromboembolic events and guide oral anticoagulation. Diagnosis of AF strongly depends on the duration of electrocardiogram monitoring. The aim of this study was to use established scores to predict the prevalence of AF.MethodsThe CHADS2- (Congestive Heart failure, hypertension, Age >75 years, Diabetes, Stroke [doubled]) and CHA2DS2VASc-score (Congestive Heart failure, hypertension, Age ≥75 years [doubled], Diabetes, Stroke [doubled], Vascular disease, Age 65–74 years, Sex category [female sex]) was calculated in 150,408 consecutive patients, referred to the University Hospital of Rostock between 2007 and 2012. All factors constituting these scores and a history of AF were prospectively documented with the ICD-10 admission codes.ResultsMean age of our study population was 67.6 ± 13.6 years with a mean CHADS2-score of 1.65 ± 0.92 and CHA2DS2VASc-score of 3.04 ± 1.42. AF was prevalent in 15.9% of the participants. The prevalence of AF increased significantly with every CHADS2- and CHA2DS2VASc-score point up to 54.2% in CHADS2-score of 6 and 71.4% in CHA2DS2VASc-score of 9 (P < 0.001).ConclusionThe prevalence of AF increases with increasing CHADS2- and CHA2DS2VASc-score. In intermediate scores intensified monitoring may be recommended. In high scores, thromboembolic complications occurred irrespective of the presence of AF and anticoagulant therapy may be initiated irrespective of documented AF.

CHADS₂ and CHA₂DS₂-VASc Scores Predict the Risk of Ischemic Stroke Outcome in Patients with Interatrial Block without Atrial Fibrillation

“…In a study by Mitchell and colleagues 17 ) , the CHADS 2 and CHA 2 DS 2 -VASc scores were predictive for subsequent hospital discharge with a diagnosis of AF in acute coronary syndrome. In 2013, Chao and colleagues 39 ) also reported that the incidence of AF progressively increased when patients had more complicated systemic diseases, as indicated by a high CHADS 2 score; this is in agreement with the finding of Tischer and colleagues that the prevalence of AF increases with increasing CHADS 2 and CHA 2 DS 2 -VASc scores 40 ) . These studies support the finding that higher CHADS 2 and CHA 2 DS 2 -VASc scores can identify patients who are more likely to develop asymptomatic AF.…”

Cost Saving Potential of an Early Detection of Atrial Fibrillation in Patients after ICD Implantation

“…Since we referred in our model to the 2016 ESC Guidelines for the management of atrial fibrillation, we did not take into account cost-effectiveness measurement in a model which is based on a possible future concept of OAC therapy in patients without documented AF but with elevated stroke risk. So a study by Tischer et al found that, in patients with high CHA2DS2VASc-scores, thromboembolic complications occurred irrespective of the presence of AF and concluded that anticoagulant therapy may be initiated irrespective of documented AF [ 38 ]. But superiority of this new concept for prevention of stroke has not been proven so far.…”

How and When to Screen for Atrial Fibrillation after Stroke: Insights from Insertable Cardiac Monitoring Devices

“…While CHADS 2 /CHA 2 DS 2 -VASc score has been found to increase the risk of AF [ 41 ], this parameter has not been recognized as a significant risk factor in the post-CS setting [ 24 , 40 ]. This may be due to sample size issues or the high prevalence of elevated CHADS 2 /CHA 2 DS 2 -VASc score in this secondary prevention population.…”