The CHADS2 and CHA2DS2-VASc scores for predicting ischemic stroke among East Asian patients with atrial fibrillation: A systemic review and meta-analysis

Xiong, Qinmei; Chen, Sisi; Senoo, Keitaro; Proietti, Marco; Hong, Kui; Lip, Gregory Y. H.

doi:10.1016/j.ijcard.2015.05.115

Cited by 25 publications

(12 citation statements)

References 27 publications

(46 reference statements)

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“…10,[26][27][28][29][30] Indeed, the CHA 2 DS 2 -VASc score has been shown to consistently better than the older CHADS 2 score in identifying low-risk patients, even among Asian patients. 31 Take our previous study for example, among 25 286 Asian AF patients with a CHADS 2 score of 0, the CHA 2 DS 2 -VASc scores of these subjects ranged from 0 to 3, and the annual risk of ischemic stroke can be as high as 4.47%. 4 However, the risk of ischemic stroke was still 1.15%/y for patients with a CHA 2 DS 2 -VASc score of 0, which is above the suggested threshold for the initiation of NOACs (0.9%/y).…”

Section: Discussionmentioning

confidence: 94%

Validation of a Modified CHA ₂ DS ₂ -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation

Chao

Lip

Liu

et al. 2016

Stroke

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A trial fibrillation (AF) confers a 5-fold increased risk of stroke compared with patients without AF. 1 The risk of AF-associated stroke is not homogeneous and depends on patients' age and comorbidities, which have resulted in the development of clinical scores to aid stroke risk stratification and guide the use of oral anticoagulation (OAC) for stroke prevention. Currently, the CHA 2 DS 2 -VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65-74 years, female) score is recommended by guidelines for stroke risk stratification in AF 2,3 and has been shown to be better than the older CHADS 2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and prior stroke or transient ischemic attack) score for stroke risk stratification among Asian AF patients. 4 Because age is an important driver of ischemic stroke for AF patients, 5 the CHA 2 DS 2 -VASc scheme assigns 1 point forBackground and Purpose-The age threshold for an increased stroke risk for patients with atrial fibrillation may be different for Asians and non-Asians. We hypothesized that a modified CHA 2 DS 2 -VASc (congestive heart failure, hypertension, age ≥75, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65-74 years, female) scheme, mCHA 2 DS 2 -VASc, which assigned one point for patients aged 50 to 74 years, may perform better than CHA 2 DS 2 -VASc score for stroke risk stratification in Asians. Methods-This study used the Taiwan National Health Insurance Research Database, which included 224 866 newly diagnosed atrial fibrillation patients. The predictive accuracies of ischemic stroke of CHA 2 DS 2 -VASc and mCHA 2 DS 2 -VASc scores were compared among 124 271 patients without antithrombotic therapies. From the whole cohort, 15 948 patients had a CHA 2 DS 2 -VASc score 0 (males) or 1 (females), and 8654 patients had an mCHA 2 DS 2 -VASc score 1 (males) or 2 (females). The latter were categorized into 3 groups, that is, no treatment, antiplatelet therapy, and warfarin, and the risks of ischemic stroke and intracranial hemorrhage (ICH) were compared. Results-During a follow-up of 538 653 person-years, 21 008 patients experienced ischemic stroke. The mCHA 2 DS 2 -VASc performed better than CHA 2 DS 2 -VASc score in predicting ischemic stroke assessed by C indexes and net reclassification index. For 8654 patients having an mCHA 2 DS 2 -VASc score of 1 (males) or 2 (females) because of the resetting of the age threshold, use of warfarin was associated with a 30% lower risk of ischemic stroke and a similar risk of ICH compared with nontreatment. Net clinical benefit analyses also favored the use of warfarin in different weighted models. patients aged between 65 and 74 years and 2 points for those aged ≥75 years. 6 However, the age threshold for an increased risk of ischemic stroke for Asians may be lower than that of Caucasians. Conclusions-In7 For Asian AF patients with a CHA 2 DS 2 -VASc score of 0 (males)...

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Section: Discussionmentioning

confidence: 94%

Validation of a Modified CHA ₂ DS ₂ -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation

Chao

Lip

Liu

et al. 2016

Stroke

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“…AF patients other than those having “valvular AF” are known to have non-valvular AF (NVAF). As stroke risk among NVAF patients vary, different stroke risk stratification tools including the CHADS 2 score have been used over the years and currently the CHA 2 DS 2 -VASc score is recommended [ 9 , 22 , 23 ]. NVAF patients can be stratified into low, intermediate, and high risk to stroke depending on whether their CHA 2 DS 2 -VASc scores are 0, 1, or ≥ 2, respectively.…”

Section: Introductionmentioning

confidence: 99%

Poor outcomes associated with antithrombotic undertreatment in patients with atrial fibrillation attending Gondar University Hospital: a retrospective cohort study

2018

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BackgroundAtrial fibrillation (AF) is a major risk factor for stroke as it increases the incidence of stroke nearly fivefold. Antithrombotic treatment is recommended for the prevention of stroke in AF patients. However, majorly due to fear of risk of bleeding, adherence to recommendations is not observed. The aim of this study was to investigate the impact of antithrombotic undertreatment, on ischemic stroke and/or all-cause mortality in patients with AF.MethodsA retrospective cohort study was conducted from January 7, 2017 to April 30 2017 using medical records of patients with AF attending Gondar University Hospital (GUH) between November 2012 and September 2016. Patients receiving appropriate antithrombotic management and those on undertreatment, were followed for development of ischemic stroke and/or all-cause mortality. Kaplan-Meier and a log-rank test was used to plot the survival analysis curve. Cox regression was used to determine the predictors of guideline-adherent antithrombotic therapy.ResultsThe final analysis included 159 AF patients with a median age of 60 years. Of these, nearly two third (64.78%) of patients were receiving undertreatment for antithrombotic medications. Upon multivariate analysis, history of ischemic stroke/transient ischemic attack (TIA) was associated with lower incidence of antithrombotic undertreatment. A significant increase (HR: 8.194, 95% CI: 2.911–23.066)] in the incidence of ischemic stroke and/or all-cause mortality was observed in patients with undertreatment. Up-on multivariate analysis, only increased age was associated with a statistically significant increase incidence of ischemic stroke and/or all-cause mortality, while only history of ischemic stroke/TIA was associated with a decrease in the risk of ischemic stroke and/or all-cause mortality.ConclusionAdherence to antithrombotic guideline recommendations was found to be crucial in reducing the incidence of ischemic stroke and/or all-cause mortality in patients with AF without increasing the risk of bleeding. However, undertreatment to antithrombotic medications was found to be high (64.78%) and was associated with poorer outcomes in terms of ischemic stroke and/or all-cause mortality. Impact on practice: This research highlighted the magnitude of antithrombotic undertreatment and its impact on ischemic stroke and/or all-cause mortality in patients with AF. This article has to alert prescribers to routinely evaluate AF patients’ risk for ischemic stroke and provide appropriate interventions based on guideline recommendations.

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“…More than half of all cardioembolic strokes are related to AF . There is evidence indicating that the CHA 2 DS 2 ‐VASc score may be more clinically useful for predicting stroke in patients with AF than the CHADS 2 score …”

Section: Introductionmentioning

confidence: 99%

CHA₂DS₂‐VASc scores for outcome prediction in acute ischaemic stroke

Tsao

Chen

et al. 2018

Eur J Clin Investigation

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The CHADS2 and CHA2DS2-VASc scores for predicting ischemic stroke among East Asian patients with atrial fibrillation: A systemic review and meta-analysis

Cited by 25 publications

References 27 publications

Validation of a Modified CHA ₂ DS ₂ -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation

Validation of a Modified CHA ₂ DS ₂ -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation

Poor outcomes associated with antithrombotic undertreatment in patients with atrial fibrillation attending Gondar University Hospital: a retrospective cohort study

CHA₂DS₂‐VASc scores for outcome prediction in acute ischaemic stroke

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The CHADS2 and CHA2DS2-VASc scores for predicting ischemic stroke among East Asian patients with atrial fibrillation: A systemic review and meta-analysis

Cited by 25 publications

References 27 publications

Validation of a Modified CHA 2 DS 2 -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation

Validation of a Modified CHA 2 DS 2 -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation

Poor outcomes associated with antithrombotic undertreatment in patients with atrial fibrillation attending Gondar University Hospital: a retrospective cohort study

CHA2DS2‐VASc scores for outcome prediction in acute ischaemic stroke

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Validation of a Modified CHA ₂ DS ₂ -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation

Validation of a Modified CHA ₂ DS ₂ -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation

CHA₂DS₂‐VASc scores for outcome prediction in acute ischaemic stroke