CHADS&lt;sub&gt;2&lt;/sub&gt;, CHA&lt;sub&gt;2&lt;/sub&gt;DS&lt;sub&gt;2&lt;/sub&gt;-VASc, and R&lt;sub&gt;2&lt;/sub&gt;CHADS&lt;sub&gt;2&lt;/sub&gt; Scores Are Associated With 3-Month Functional Outcome of Stroke in Patients With Prior Coronary Artery Disease

Hoshino, Takao; Ishizuka, Kôzô; Shimizu, Satoru; Uchiyama, Shinichiro

doi:10.1253/circj.cj-14-0038

Cited by 15 publications

(17 citation statements)

References 34 publications

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“…Also, he considers the CHA2DS2-VASc score as "very complicated". Interestingly, the Editorial by Ikeda was a comment on an original article by Hoshino et al, 4 which showed that the CHADS2, R2CHADS2 and CHA2DS2-VASc scores are associated with 3-month functional outcomes (based on a modified Rankin scale) of stroke in a small (and underpowered) heterogeneous cohort of patients with prior coronary artery disease (n=139; AF in only 28.8%). Indeed, 11.8% of the patients were being anticoagulated and analyses of functional outcomes were performed by logistic regression rather than time-to-event survival analysis.…”

Section: Editorial P 1331 Article P 1481mentioning

confidence: 99%

Modern Management of Atrial Fibrillation Requires Initial Identification of “Low-Risk” Patients Using the CHA2DS2-VASc Score, and Not Focusing on “High-Risk” Prediction

Lip

Lane

2014

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp statistics approximately 0.6-0.7), but this depends on the study setting and design. In one of the largest validation cohorts, 5 CHA2DS2-VASc had a c-statistic of 0.850, which outperformed the CHADS2 score (c-statistic 0.722) in predicting "high-risk" patients who developed thromboembolism; importantly, CHA2DS2-VASc was also better than CHADS2 in defining those patients at low-risk of thromboembolism. The other risk score referred to by Ikeda, the R2CHADS2 score, has many limitations that have been well recognised, notwithstanding its initial derivation from a selected trial anticoagulated cohort that did not include the range of stroke risk and excluded those with severe renal impairment. 6 Also, other "real world" studies have shown that adding extra points for "renal impairment" (as with the R2CHADS2 score) did not improve the predictive value of CHA2DS2-VASc. 7-9Nonetheless, various attempts to improve prediction of "highrisk" AF subjects using biomarkers have been proposed, but the (very) marginal improvements in c-statistics over clinical-based scores were at the cost of substantially much lower simplicity and applicability for everyday clinical practice.If Ikeda assumes that "a simple score is better," then classifying patients as "low-risk" using the CHADS2 score is simply putting many AF patients at risk of fatal and devastating strokes. In the Danish nationwide cohort study, based on >17,300 patients with a CHADS2 score=0, stroke rates were as high as 3.2% (with the upper boundary of the 95% CI as high as 6.4%) per year. 10 Would anyone reasonably withhold anticoagulation therapy for a 74-year-old female patient with AF and prior peripheral artery disease? Such a hypothetical patient would have a CHADS2 score=0 ("low risk"), but a CHA2DS2-VASc score=3 (for which anticoagulation is recommended). A comparison of CHA2DS2-VASc, CHADS2 and the van Walraven scores found that only the CHA2DS2-VASc score was a significant predictor of the absence of thromboembolism for a cohort of lone AF patients followed up over 12 years. 11If CHA2DS2-VASc is "very complicated", then Ikeda should be reassured that a recent survey of European clinical practice demonstrated uptake and use of this score in 97.7% of respondents whereas the HAS-BLED score was used by >78% for the assessment of bleeding-risk. 12 The EORP-AF survey found that anticoagulation rates were approx 80%, especially for lthough atrial fibrillation (AF) increases the risk of stroke, this risk is not homogeneous and depends on associated stroke risk factors, which have resulted in clinical scores to aid stroke risk stratification of AF patients. When vitamin K antagonists (VKAs) were the only option for oral anticoagulation, the focus was on the identification of "high risk" patients to be targeted for (inconvenient) VKA treatment. However, the landscape of thromboprophylaxis has changed markedly with the improvements in our understanding of how to use the VKAs ...

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Section: Editorial P 1331 Article P 1481mentioning

confidence: 99%

Modern Management of Atrial Fibrillation Requires Initial Identification of “Low-Risk” Patients Using the CHA2DS2-VASc Score, and Not Focusing on “High-Risk” Prediction

Lip

Lane

2014

Circ J

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“…One hundred twelve patients (32.6%) received prior anticoagulants including warfarin The median NIHSS score on admission was 10 (IQR, 3-18.75). There was a significant difference in NIHSS score on admission between patients with and without prior anticoagulation therapy (7 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] versus 11 [3.25-19], P 5 .037). The NIHSS score on admission was positively correlated with pre-admission CHADS 2 (r 5 .116, P 5 .031), CHA 2 DS 2 -VASc (r 5 .166, P 5 .020), and R 2 CHADS 2 score (r 5 .106, P 5 .049; Fig 1).…”

Section: Resultsmentioning

confidence: 99%

“…Indeed, all pre-admission CHADS 2 , CHA 2 DS 2 -VASc, and R 2 CHADS 2 scores were recently reported to be associated with the 3-month functional outcome in patients with acute stroke subsequent to coronary artery diseases. 15 However, the associations between these 3 pre-admission risk scores and severity on admission and functional outcome of acute ischemic stroke patients with AF are unknown.…”

mentioning

confidence: 99%

Pre-admission CHADS2, CHA2DS2-VASc, and R2CHADS2 Scores on Severity and Functional Outcome in Acute Ischemic Stroke with Atrial Fibrillation

Tanaka

Yamada

Torii

et al. 2015

Journal of Stroke and Cerebrovascular Diseases

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“…Hoshino T et al . found that CHADS 2 and CHA 2 DS 2 -VASc scores were useful in predicting functional status after stroke in CAD patients 34 . Both the CHADS 2 and CHA 2 DS 2 -VASc scores were used to predict contrast-induced nephropathy (CIN) in patients with CAD who underwent urgent percutaneous coronary intervention (PCI) 35 .…”

Section: Discussionmentioning

confidence: 98%

Predictive value of CHADS2 and CHA2DS2-VASc scores for acute myocardial infarction in patients with atrial fibrillation

Hui

Han

et al. 2017

Sci Rep

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The presence of acute myocardial infarction (AMI) confers a poor prognosis in atrial fibrillation (AF), associated with increased mortality dramatically. This study aimed to evaluate the predictive value of CHADS2 and CHA2DS2-VASc scores for AMI in patients with AF. This retrospective study enrolled 5140 consecutive nonvalvular AF patients, 300 patients with AMI and 4840 patients without AMI. We identified the optimal cut-off values of the CHADS2 and CHA2DS2-VASc scores each based on receiver operating characteristic curves to predict the risk of AMI. Both CHADS2 score and CHA2DS2-VASc score were associated with an increased odds ratio of the prevalence of AMI in patients with AF, after adjustment for hyperlipidaemia, hyperuricemia, hyperthyroidism, hypothyroidism and obstructive sleep apnea. The present results showed that the area under the curve (AUC) for CHADS2 score was 0.787 with a similar accuracy of the CHA2DS2-VASc score (AUC 0.750) in predicting “high-risk” AF patients who developed AMI. However, the predictive accuracy of the two clinical-based risk scores was fair. The CHA2DS2-VASc score has fair predictive value for identifying high-risk patients with AF and is not significantly superior to CHADS2 in predicting patients who develop AMI.

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CHADS<sub>2</sub>, CHA<sub>2</sub>DS<sub>2</sub>-VASc, and R<sub>2</sub>CHADS<sub>2</sub> Scores Are Associated With 3-Month Functional Outcome of Stroke in Patients With Prior Coronary Artery Disease

Cited by 15 publications

References 34 publications

Modern Management of Atrial Fibrillation Requires Initial Identification of “Low-Risk” Patients Using the CHA<sub>2</sub>DS<sub>2</sub>-VASc Score, and Not Focusing on “High-Risk” Prediction

Modern Management of Atrial Fibrillation Requires Initial Identification of “Low-Risk” Patients Using the CHA<sub>2</sub>DS<sub>2</sub>-VASc Score, and Not Focusing on “High-Risk” Prediction

Pre-admission CHADS2, CHA2DS2-VASc, and R2CHADS2 Scores on Severity and Functional Outcome in Acute Ischemic Stroke with Atrial Fibrillation

Predictive value of CHADS2 and CHA2DS2-VASc scores for acute myocardial infarction in patients with atrial fibrillation

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