Prediction of new-onset atrial fibrillation after first-ever ischemic stroke: A comparison of CHADS 2 , CHA 2 DS 2 -VASc and HATCH scores and the added value of stroke severity

Hsieh, Cheng Yang; Lee, Cheng‐Han; Wu, Darren Philbert; Sung, Sheng Feng

doi:10.1016/j.atherosclerosis.2018.03.024

Cited by 25 publications

(29 citation statements)

References 50 publications

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“…The Kaplan-Meier curves were computed to present the survival rates free from AF during follow-up, after dividing patients into 3 groups (low-, medium-, and high-risk) according to the new score. [21][22][23] we also performed an exploratory analysis to investigate how the C 2 HEST score compares against these scores.…”

Section: Discussionmentioning

confidence: 99%

A Simple Clinical Risk Score (C2HEST) for Predicting Incident Atrial Fibrillation in Asian Subjects

Pastori

Farcomeni

et al. 2019

Chest

145

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BACKGROUND: The incidence of atrial fibrillation (AF) is increasing, conferring a major health-care issue in Asia. No risk score for predicting incident AF has been specifically developed in Asian subjects. Our aim was to investigate risk factors for incident AF in Asian subjects and to combine them into a simple clinical risk score. METHODS: Risk factors for incident AF were analyzed in 471,446 subjects from the Chinese Yunnan Insurance Database (internal derivation cohort) and then combined into a simple clinical risk score. External application of the new score was performed in 451,199 subjects from the Korean National Health Insurance Service (external cohort). RESULTS: In the internal cohort, structural heart disease (SHD), heart failure (HF), age $ 75 years, coronary artery disease (CAD), hyperthyroidism, COPD, and hypertension were associated with incident AF. Given the low prevalence and the strong association of SHD with incident AF (hazard ratio, 26.07; 95% CI, 18.22-37.30; P < .001), these patients should be independently considered as high risk for AF and were excluded from the analysis. The remaining predictors were combined into the new simple C 2 HEST score: C 2 : CAD/COPD (1 point each); H: hypertension (1 point); E: elderly (age $ 75 years, 2 points); S: systolic HF (2 points); and T: thyroid disease (hyperthyroidism, 1 point). The C 2 HEST score showed good discrimination with the area under the curve (AUC) of 0.75 (95% CI, 0.73-0.77) and had good calibration (P ¼ .774). The score was internally validated by bootstrap sampling procedure, giving an AUC of 0.75 (95% CI, 0.73-0.77). External application gave an AUC of 0.65 (95% CI, 0.65-0.66). The C 2 HEST score was superior to CHADS 2 and CHA 2 DS 2-VASc scores in both cohorts in predicting incident AF. CONCLUSIONS: We have developed and validated the C 2 HEST score as a simple clinical tool to assess the individual risk of developing AF in the Asian population without SHD.

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Section: Discussionmentioning

confidence: 99%

A Simple Clinical Risk Score (C2HEST) for Predicting Incident Atrial Fibrillation in Asian Subjects

Pastori

Farcomeni

et al. 2019

Chest

145

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“…Atrial fibrillation is one of the common causes of ischemic stroke. Early detection and treatment of atrial fibrillation is an important measure to prevent ischemic stroke [25][26][27][28]. Many studies showed that atrial fibrillation was associated with severe cerebral infarction.…”

Section: Discussionmentioning

confidence: 99%

Derivation of a Prediction Rule for Unfavorable Outcome after Ischemic Stroke in the Chinese Population

Mao

Pan

et al. 2019

Journal of Stroke and Cerebrovascular Diseases

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Background: Efficient assessment of patients after ischemic stroke has important reference value for doctors to choose appropriate treatment and rehabilitation method for patients. Our study aimed to develop a new prognostic model for predicting outcomes three months after ischemic stroke among Chinese Population． Methods: A prospective observational cohort study among ischemic stroke patients presenting to Emergency Department in the Second Affiliated Hospital of Guangzhou Medical University was conducted from May 2012 to June 2013. Demographic data of ischemic stroke patients, assessment of NIHSS and laboratory results were collected. Based on three-month modified Rankin Scale (mRS) ischemic stroke patients were divided into either favorable outcome (mRS: 0-2) or unfavorable outcome groups (mRS: 3-6). The variables closely associated with prognosis of ischemic stroke were selected to develop the new prognostic model consisted of four parameters: NIHSS, age, atrial fibrillation (AF), prealbumin (PA). The prognostic value of the modified prognostic model (NAAP: NIHSS+Age+AF+PA) was then compared with NIHSS alone.Results: A total of 454 patients with suspected stroke were recruited. 186 patients with ischemic stroke were included in the final analysis. There were 105 (56.5%) cases of ischemic stroke with favorable outcome, and 81 (43.5%) cases of ischemic stroke with unfavorable outcome. A new prognostic model, NAAP was developed.The area under curve (AUC) of NAAP was 0.861 (95%CI: 0.803-0.907), whilst the AUC of NIHSS was 0.783 (95%CI: 0.717-0.840), (P=0.0048). Decision curve analysis (DCA) showed that NAAP had a higher net benefit for threshold probabilities of 65% for predictive risk of poor outcomes. Conclusion:The modified prognostic model, NAAP may be a better prognostic tool for predicting 3-month unfavorable outcomes for ischemic stroke than NIHSS alone.

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“…Previously, a higher NIHSS score was identified as a predictor of pAF [ 35 ], and adding stroke severity to existing risk scores (e.g., the CHADS 2 and CHA 2 DS 2 -VASc scores) improved their ability to predict newly diagnosed AF [ 36 ]. However, we did not include stroke severity in the ABCD-SD score.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Novel Score for Predicting Paroxysmal Atrial Fibrillation in Acute Ischemic Stroke

Lee

Kuo

Lee

et al. 2022

IJERPH

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Atrial fibrillation (AF)—whether paroxysmal or sustained—increases the risk of stroke. We developed and validated a risk score for identifying patients at risk of paroxysmal atrial fibrillation (pAF) after acute ischemic stroke (AIS). A total of 6033 patients with AIS who received 24 h Holter monitoring were identified in the Chang Gung Research Database. Among the identified patients, 5290 with pAF and without AF were included in the multivariable logistic regression analysis to develop the pAF prediction model. The ABCD-SD score (Age, Systolic Blood pressure, Coronary artery disease, Dyslipidemia, and Standard Deviation of heart rate) comprises age (+2 points for every 10 years), systolic blood pressure (−1 point for every 20 mmHg), coronary artery disease (+2 points), dyslipidemia (−2 points), and standard deviation of heart rate (+2 points for every 3 beats per minute). Overall, 5.2% (274/5290) of patients had pAF. The pAF risk ranged from 0.8% (ABCD-SD score ≤ 7) to 18.3% (ABCD-SD score ≥ 15). The model achieved an area under the receiver operating characteristic curve (AUROCC) of 0.767 in the model development group. The ABCD-SD score could aid clinicians in identifying patients with AIS at risk of pAF for advanced cardiac monitoring.

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Prediction of new-onset atrial fibrillation after first-ever ischemic stroke: A comparison of CHADS 2 , CHA 2 DS 2 -VASc and HATCH scores and the added value of stroke severity

Cited by 25 publications

References 50 publications

A Simple Clinical Risk Score (C2HEST) for Predicting Incident Atrial Fibrillation in Asian Subjects

A Simple Clinical Risk Score (C2HEST) for Predicting Incident Atrial Fibrillation in Asian Subjects

Derivation of a Prediction Rule for Unfavorable Outcome after Ischemic Stroke in the Chinese Population

Development and Validation of a Novel Score for Predicting Paroxysmal Atrial Fibrillation in Acute Ischemic Stroke

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