Differences among Clinical Classification Schemes for Predicting Stroke in Atrial Fibrillation: Implications for Therapy in Daily Practice

Laguna, Pedro; Martı́n, Alfonso; Arco, Carmen del; Millán, Isabel; Gargantilla, Pedro

doi:10.1197/j.aem.2005.04.018

Cited by 11 publications

(4 citation statements)

References 35 publications

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“…Goto et al assessed the distribution of the CHADS2 11 score in patients with and at high risk of atherothrombosis and its relation to cerebrovascular outcomes. 11,25 They concluded that, in patients with AF, CV events, especially non-fatal stroke, and the combined end point of CV death/MI/stroke, were more frequent in the higher CHADS2 score subgroup (the rate of CV death/MI/ stroke varied from 3.9% in the CHADS2 score-0 group to 12.4% in the CHADS2 score-6 group). 4 In the current study, the calculated CHADS2 risk score was also significantly differing between the two groups, with a higher CHADS2 score in those patients with AF as compared to those without AF.…”

Section: Identification Of Af Patients At Increased Risk Of Adverse Outcomementioning

confidence: 99%

Prognosis of Atrial Fibrillation in Patients with Symptomatic Peripheral Arterial Disease: Data from the REduction of Atherothrombosis for Continued Health (REACH) Registry

Winkel

Hoeks

Schouten

et al. 2010

European Journal of Vascular and Endovascular Surgery

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Section: Identification Of Af Patients At Increased Risk Of Adverse Outcomementioning

confidence: 99%

Prognosis of Atrial Fibrillation in Patients with Symptomatic Peripheral Arterial Disease: Data from the REduction of Atherothrombosis for Continued Health (REACH) Registry

Winkel

Hoeks

Schouten

et al. 2010

European Journal of Vascular and Endovascular Surgery

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“…Multiple stroke risk stratification schemes for atrial fibrillation patients have been proposed based on various combinations of clinical and echocardiographic predictors. 1 Although there is considerable overlap, differences alter the predicted risk status of hundreds of thousands of atrial fibrillation patients, [2][3][4] contributing to the inconsistent use of anticoagulation. 5 Here, we compare 12 published schemes that stratify stroke risk in patients with nonvalvular atrial fibrillation.…”

mentioning

confidence: 99%

Comparison of 12 Risk Stratification Schemes to Predict Stroke in Patients With Nonvalvular Atrial Fibrillation

2008

Stroke

217

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Background and Purpose-More than a dozen schemes for stratifying stroke risk in patients with nonvalvular atrial fibrillation have been published. Differences among these schemes lead to inconsistent stroke risk estimates for many atrial fibrillation patients, resulting in confusion among clinicians and nonuniform use of anticoagulation. Methods-Twelve published schemes stratifying stroke risk in patients with nonvalvular atrial fibrillation are analyzed, and observed stroke rates in independent test cohorts are compared with predicted risk status. Results-Seven schemes were based directly on event-rate analyses, whereas 5 resulted from expert consensus. Four considered only clinical features, whereas 7 schemes included echocardiographic variables. The number of variables per scheme ranged from 4 to 8 (median, 6). The most frequently included features were previous stroke/TIA (100% of schemes), patient age (83%), hypertension (83%), and diabetes (83%), and 8 additional variables were included in Ն1 schemes. Based on published test cohorts, all 8 tested schemes stratified stroke risk, but the absolute stroke rates varied widely. Observed rates for those categorized as low risk ranged from 0% to 2.3% per year and those categorized as high risk ranged from 2.5% to 7.9% per year. When applied to the same cohorts, the fractions of patients categorized by the different schemes as low risk varied from 9% to 49% and those categorized by the different schemes as high-risk varied from 11% to 77%. Conclusions-There are substantial, clinically relevant differences among published schemes designed to stratify stroke risk in patients with atrial fibrillation. Additional research to identify an optimum scheme for primary prevention and subsequent standardization of recommendations may lead to more uniform selection of patients for anticoagulant prophylaxsis.

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“…The very large scaled AFFIRM and AF-CHF clinical trials compared rate and rhythm control, but did not explore the optimal management for recent-onset AF/AFL patients presenting to the ED with in 48 hours of symptoms [9][10]. Although international standard guidelines are available, AF treatment in ED is still heterogeneous in terms of the management strategy chosen [11][12][13][14][15][16][17]. According to results of many clinical trials showing disparities in management of AF in ED, national based guidelines or consensus documents specific to ED management of AF has recently been developed and published in order to solve this problem [18][19].…”

Section: Introductionmentioning

confidence: 99%

Cardioversion of recent-onset atrial fibrillation and flutter in the emergency department

Beton¹,

Yılmaz²,

Korkmaz³

et al. 2014

Cumhuriyet Med J

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Atrial fibrillation (AF) is the most common arrhythmia encountered in acute medical practice. One-third of hospitalizations for cardiac rhythm disturbances are attributed to AF, with increasing rates in the past decade. Significant morbidity and mortality, including 15% to 20% of all ischemic strokes and 20% of all strokes, result from AF. The overall mortality rate for patients with AF is approximately double that for patients in normal sinus rhythm. Atrial flutter (AFL) has many clinical aspects that are similar to AF, AF and AFL have same management strategies in emergency settings. The major goals of treatment include alleviation of the associated symptoms and/or hemodynamic disturbance, reduction of the risk of systemic thromboembolism, reduction in hospital length of stay. The very large scaled AFFIRM and AF-CHF clinical trials compared rate and rhythm control (cardioversion), but did not explore the optimal management for recent-onset AF/AFL patients presenting to the emergency department (ED) with in 48 hours of symptoms. Although international standard guidelines are available, AF treatment in ED is still heterogeneous in terms of the management strategy (rate or rhythm) chosen. National based guidelines or consensus documents specific to ED management of AF has recently been developed and published in order to solve this problem. Aim of this review is to give detailed information for ED team about echocardiographic criterias supporting cardioversion (CV) of AF, CV procedure itself and new antiarrhythmic and oral anticoagulant drugs by adhering to the guidelines. Keywords: Cardioversion, recent-onset atrial fibrillation, flutter, emergency ÖzetAtriyal fibrilasyon, akut tıbbi uygulamada karşılaşılan en sık aritmidir. Kalp ritm bozuklukları nedeniyle hastaneye yatanların üçte birinde neden AF olup son on yılda sıklığı giderek artmaktadır. AF belirgin mortalite ve morbiditeye neden olmaktadır. Tüm iskemik inmelerin %15-%20'si ve tüm inmelerin %20'si AF nedenlidir. AF'si olan hastalarda genel ölüm oranı, normal sinus ritmi olanlara göre yaklaşık iki kat fazladır. Atriyal flutter (AFL)'in AF'e benzer birçok klinik yönleri bulnumaktadır, acil durumlarda AF ve AFL aynı tedavi stratejilerine sahiptir. Tedavinin başlıca hedefleri, ilgili semptom ve/veya hemodinamik bozukluğun azaltılması, sistemik tromboembolik riskin azaltılması ve hastanede kalış süresinin kısaltılmasını içermektedir. Çok büyük ölçekli AFFIRM ve AF-CHF çalışmaları, hız ve ritim kontrolü (kardiyoversiyon) stratejilerini kıyasladı, fakat, semptom başlangıcının 48 saati içerisinde acile servise(AS) başvuran, yeni başlangıçlı AF/AFL hastalarında optimal tedavi yöntemini açığa kavuşturamadı. Uluslararası standart kılavuzlar bulunmasına rağmen AS'de AF tedavisi, seçilen tedavi stratejisi (hız veya ritim) yönünden hala heterojendir. Son zamanlarda bu sorunu çözmek amacıyla, AS'de AF tedavisine yönelik ulusal kaynaklı kılavuzlar ve konsensüs belgeleri geliştirilmiş ve yayınlanmıştır. Bu derlemenin amacı, AS ekibine, kılavuzlara bağlı kalınarak...

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Differences among Clinical Classification Schemes for Predicting Stroke in Atrial Fibrillation: Implications for Therapy in Daily Practice

Cited by 11 publications

References 35 publications

Prognosis of Atrial Fibrillation in Patients with Symptomatic Peripheral Arterial Disease: Data from the REduction of Atherothrombosis for Continued Health (REACH) Registry

Prognosis of Atrial Fibrillation in Patients with Symptomatic Peripheral Arterial Disease: Data from the REduction of Atherothrombosis for Continued Health (REACH) Registry

Comparison of 12 Risk Stratification Schemes to Predict Stroke in Patients With Nonvalvular Atrial Fibrillation

Cardioversion of recent-onset atrial fibrillation and flutter in the emergency department

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