Comparisons of CHADS2 and CHA2DS2-VASc scores for stroke risk stratification in atrial fibrillation: Which scoring system should be used for Asians?

Chao, Tze Fan; Liu, Chia Jen; Tuan, Ta Chuan; Chen, Su Jung; Wang, Kang Ling; Lin, Yenn Jiang; Chang, Shih Lin; Lo, Li Wei; Hu, Yu Feng; Chen, Tzeng Ji; Chiang, Chern En; Chen, Shih Ann

doi:10.1016/j.hrthm.2015.08.017

Cited by 73 publications

(51 citation statements)

References 35 publications

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“…In the 9 AF cohorts with at least 5000 patients not taking OAC8, 14, 15, 16, 17, 18, 19, 20, 21 identified in our systematic review, overall event rates ranged from 0.45% to 7.03% per year (median of 2.99% per year). Event rates differed markedly between national cohorts from adjacent geographic regions (eg, Sweden and Denmark) as well as cohorts from the same country (eg, the 2 Taiwanese cohorts) (Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…The Israel Clalit study also included transient ischemic attack, the Danish National Patient Registry Study included peripheral embolism and pulmonary embolism, and the ATRIA study included systemic embolism. Eight studies used ICD‐9 or ICD‐10 hospital discharge codes to identify outcome events 8, 15, 16, 17, 18, 19, 20, 21, 25. Seven of these did not specify whether nonprimary discharge diagnoses were also included; presumably they were 8, 15, 17, 18, 19, 20, 21, 25.…”

Section: Resultsmentioning

confidence: 99%

“…Only 2 studies validated outcome events via clinical record review; both of these studies had lower than median overall event rates 15, 17. Two studies used death certificates to capture outcome events; both had higher than median overall event rates8, 20 (Table 4). Three studies excluded patients from analysis if they started OACs later in follow‐up16, 21, 22 (Table 4).…”

Section: Resultsmentioning

confidence: 99%

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Methodologic Differences Across Studies of Patients With Atrial Fibrillation Lead to Varying Estimates of Stroke Risk

Quinn

Severdija

Chang

et al. 2018

JAHA

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BackgroundGuidelines for anticoagulation in atrial fibrillation (AF) assume that stroke risk scheme point scores correspond to fixed stroke rates. However, reported stroke rates vary widely across AF cohort studies, including studies from the same country. Reasons for this variation are unclear. This study compares methodologies used to assemble and analyze large AF cohorts worldwide and assesses potential bias in estimating stroke rates.Methods and ResultsFrom a previous systematic review of AF cohorts, we analyzed studies including at least 5000 patients. We assessed methods used to generate rates of ischemic stroke off anticoagulants, according to a structured inventory of database interrogation methods. Nine studies (497 578 total patients) met our criteria. Overall cohort stroke rates ranged from 0.45% to 7.03% per year. In bivariate study‐level analysis, multiple features were associated with higher stroke rates, including AF identified as inpatients versus outpatients (rate ratio 2.60, 95% confidence interval, 1.19, 5.68), and lack of clinical validation of outcome events (rate ratio 4.09, 95% confidence interval, 1.06, 15.70). European studies reported rates more than 4‐fold higher than North American studies. International Classification of Diseases (ICD) coding schemes for outcomes varied widely. Multiple high rate features coexisted in the same studies.ConclusionsAmong AF cohort studies, differences in the composition, method of assembly, determination of clinical features and outcomes, and analytic approach were strongly associated with reported stroke rates. Our study highlights the need for standardized and validated methodologies for AF cohort assembly and analysis to generate accurate stroke rates to better support anticoagulation guidelines for patients with AF.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Methodologic Differences Across Studies of Patients With Atrial Fibrillation Lead to Varying Estimates of Stroke Risk

Quinn

Severdija

Chang

et al. 2018

JAHA

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“…Recommendations for these patients were less clear in the 2014 American College of Cardiology and American Heart Association AF guidelines, which suggested that “no antithrombotic therapy, aspirin or an OAC” be considered (class IIb recommendation) 4. Numerous registry studies and randomized trials suggested that the risk of ischemic stroke is higher for Asian compared with non‐Asian AF patients 8, 17, 18, 19, 20. We showed, for example, that the annual risk of ischemic stroke was 2.75% for Asian men with AF and a CHA 2 DS 2 ‐VASc score of 1 and 2.55% for Asian women with AF and a CHA 2 DS 2 ‐VASc score of 25; therefore, these patients should receive OACs for stroke prevention, given the greater mortality and disability for AF‐related strokes.…”

Section: Discussionmentioning

confidence: 99%

“…The study protocol of the present study is similar to that of our previous studies 5, 7, 8, 9, 10, 11. This study used Taiwan's National Health Insurance Research Database (NHIRD), released by the Taiwan National Health Research Institutes.…”

Section: Methodsmentioning

confidence: 99%

Is an Oral Anticoagulant Necessary for Young Atrial Fibrillation Patients With a CHA ₂ DS ₂ ‐VASc Score of 1 (Men) or 2 (Women)?

Hung

Chao

Liu

et al. 2016

JAHA

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BackgroundRecent studies demonstrated that oral anticoagulants (OACs) should be considered for patients with atrial fibrillation and 1 risk factor in addition to sex. Because age is an important determinant of ischemic stroke, the strategy for stroke prevention may be different for these patients in different age strata. The aim of this study was to investigate whether OACs should be considered for patients aged 20 to 49 years with atrial fibrillation and a CHA2DS2‐VASc score of 1 (men) or 2 (women).Methods and ResultsUsing the Taiwan National Health Insurance Research Database, 7374 male patients with atrial fibrillation and a CHA2DS2‐VASc score of 1 and 4461 female patients with atrial fibrillation and a CHA2DS2‐VASc score of 2 and all without antithrombotic therapies were identified and stratified into 3 groups by age. The threshold for the initiation of OACs for stroke prevention was set at a stroke rate of 1.7% per year for warfarin and 0.9% per year for non–vitamin K antagonist OACs. Among male patients aged 20 to 49 years with a CHA2DS2‐VASc score of 1, the risk of ischemic stroke was 1.30% per year and ranged from 0.94% per year for those with hypertension to 1.71% for those with congestive heart failure. Among female patients aged 20 to 49 years with a CHA2DS2‐VASc score of 2, the risk of ischemic stroke was 1.40% per year and ranged from 1.11% per year for those with hypertension to 1.67% for those with congestive heart failure.ConclusionsFor atrial fibrillation patients aged 20 to 49 years with 1 risk factor in addition to sex, non–vitamin K antagonist OACs should be considered for stroke prevention to minimize the risk of a potentially fatal or disabling event.

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Comparison of Clinical Outcomes Among Patients With Atrial Fibrillation or Atrial Flutter Stratified by CHA₂DS₂-VASc Score

Lin

Chen

et al. 2018

JAMA Netw Open

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Comparisons of CHADS2 and CHA2DS2-VASc scores for stroke risk stratification in atrial fibrillation: Which scoring system should be used for Asians?

Cited by 73 publications

References 35 publications

Methodologic Differences Across Studies of Patients With Atrial Fibrillation Lead to Varying Estimates of Stroke Risk

Methodologic Differences Across Studies of Patients With Atrial Fibrillation Lead to Varying Estimates of Stroke Risk

Is an Oral Anticoagulant Necessary for Young Atrial Fibrillation Patients With a CHA ₂ DS ₂ ‐VASc Score of 1 (Men) or 2 (Women)?

Comparison of Clinical Outcomes Among Patients With Atrial Fibrillation or Atrial Flutter Stratified by CHA₂DS₂-VASc Score

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Comparisons of CHADS2 and CHA2DS2-VASc scores for stroke risk stratification in atrial fibrillation: Which scoring system should be used for Asians?

Cited by 73 publications

References 35 publications

Methodologic Differences Across Studies of Patients With Atrial Fibrillation Lead to Varying Estimates of Stroke Risk

Methodologic Differences Across Studies of Patients With Atrial Fibrillation Lead to Varying Estimates of Stroke Risk

Is an Oral Anticoagulant Necessary for Young Atrial Fibrillation Patients With a CHA 2 DS 2 ‐VASc Score of 1 (Men) or 2 (Women)?

Comparison of Clinical Outcomes Among Patients With Atrial Fibrillation or Atrial Flutter Stratified by CHA2DS2-VASc Score

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Product

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Is an Oral Anticoagulant Necessary for Young Atrial Fibrillation Patients With a CHA ₂ DS ₂ ‐VASc Score of 1 (Men) or 2 (Women)?

Comparison of Clinical Outcomes Among Patients With Atrial Fibrillation or Atrial Flutter Stratified by CHA₂DS₂-VASc Score