Relationship Between CHADS2 Score and Ischemic Stroke During Rhythm Control Therapy for Paroxysmal Atrial Fibrillation

Abstract

SummaryThe CHADS 2 score has been proposed for stratifying patients with nonvalvular atrial fibrillation (NVAF) according to the risk of thromboembolism in the AHA/ACC/ESC guidelines. However, there is little information about its usefulness for predicting the long-term risk of ischemic stroke in Japanese patients with paroxysmal AF. We retrospectively evaluated the incidence of ischemic stroke and the efficacy of anticoagulant therapy in paroxysmal AF patients on rhythm control therapy who were stratified by their CHADS 2 score. The subjects were 334 NVAF patients (229 men and 105 women, mean age, 68 ± 12 years, mean follow-up period, 60 ± 35 months) who were categorized into low risk (score 0), moderate risk (1 or 2), and high risk (3 or more) groups for thromboembolism.The low, moderate, and high risk groups accounted for 34%, 50%, and 16% of the patients, respectively. Among 257 patients without warfarin therapy, the annual rate of symptomatic ischemic stroke was 0.6% in the score 0 group, 0.5% in the score 1 group, 3.1% in the score 2 group, and 9.6% in the score 3 or more group. Among 77 patients treated with warfarin (target PT-INR: 1.6-3.0), the stroke rate was 0% in the score 0 group, 0% in the score 1 group, 1.4% in the score 2 group, and 6.6% in the score 3 or more group. The annual rate of ischemic stroke was 0.88% in patients treated with warfarin versus 2.67% in those without warfarin, or a decrease in risk of 68% with warfarin (P < 0.01). In Japanese patients with paroxysmal AF, the CHADS 2 score is useful for predicting the risk of ischemic stroke. Anticoagulant therapy is needed to prevent ischemic stroke in patients with paroxysmal AF, especially those who have a CHADS 2 score of 2 or more. (Int Heart J 2010; 51: 24-29)Key words: Paroxysmal atrial fibrillation, Thromboembolism, Anticoagulant therapy, Antiarrhythmic therapy, CHADS 2 score A ccording to the results of epidemiological studies in Western countries, the incidence of atrial fibrillation (AF) is approximately 4% and 10% among persons in their seventies and eighties, respectively, showing a marked increase with age. 1) In Japan, the proportion of elderly in the population is increasing rapidly, and the incidence of AF has increased markedly compared with that in the 1980s to approximately 2% and 3.2% among persons in their seventies and eighties, respectively, although it is still less than half of the incidence reported in Western countries.2) Since the incidence of AF will continue to increase in the future, AF is recognized as a significant medical and social problem.AF is often encountered in routine medical practice and is an arrhythmia that should be actively treated and controlled, because it not only causes cardiovascular complications, including thromboembolism and heart failure, 3) but also decreases the survival of patients with impaired left ventricular function. 4) In Western countries, to prevent ischemic stroke as a serious complication of nonvalvular AF, risk stratification is performed based on the CHADS 2 score and an...

Incidence, Predictors and Impact of Severe Periprocedural Bleeding According to VARC-2 Criteria on 1-Year Clinical Outcomes in Patients After Transcatheter Aortic Valve Implantation

“…Last but not least, the occurrence of a severe bleeding may require discontinuation of an antiplatelet and antithrombotic treatment, which may lead to ischemic complications (ie, stroke) and worsened outcome. 37,38) Limitations: The main limitation of the present analysis is the small number of subjects and partially retrospective design of the study. To increase the statistical power, the LT/D and major bleeding were grouped together and further analyzed as the SBE.…”

Relationship between CHA2DS2-VASc scores and ischemic stroke/cardiovascular events in Japanese patients with paroxysmal atrial fibrillation without receiving anticoagulant therapy

“…Some researchers recommend active administration of anticoagulation therapy [25], while others advocate focusing on patient wishes and individual bleeding risks [26]. We previously investigated the annual rate of ischemic stroke with respect to CHADS 2 scores [27]. In general, the annual rate of ischemic stroke for patients with CHADS 2 scores of ≥2 points was comparable to those reported in studies published in the USA and Europe, supporting the validity of the 2008 Japanese Circulation Society guidelines on use of anticoagulation therapy in patients with AF.…”

Relationship Between CHADS₂ Score and Efficacy of Antiarrhythmic Drug Therapy in Patients With Paroxysmal Atrial Fibrillation

“…In an epidemiological study of 1,733 patients aged 65-95 years with nonvalvular AF who were discharged from hospital without anticoagulation therapy, high CHADS2 scores were associated with increased age-adjusted incidence of stroke. 13 The CHADS2 score has been reported as a useful tool in risk stratification for ischemic stroke in patients with nonvalvular paroxysmal AF in Japan, 14 but as far as we know, there have been no studies of the relationship between CHADS2 score and efficacy of AAD therapy. Because most of the patients in the present study had normal or slightly impaired LVEF (Table 1B), Class I AAD were selected as the first-line therapy in approximately 90% of all patients with paroxysmal AF.…”