Stroke Risk as a Function of Atrial Fibrillation Duration and CHA ₂ DS ₂ -VASc Score

Abstract

Background: Studies of patients with cardiovascular implantable electronic devices show a relationship between atrial fibrillation (AF) duration and stroke risk, although the interaction with CHA 2 DS 2 -VASc score is poorly defined. The objective of this study is to evaluate rates of stroke and systemic embolism (SSE) in patients with cardiovascular implantable electronic devices as a function of both CHA 2 DS 2 -VASc score and AF duration. Methods: Data from the Optum electronic health record deidentified database (2007–2017) were linked to the Medtronic CareLink database of cardiovascular implantable electronic devices capable of continuous AF monitoring. An index date was assigned as the later of either 6 months after device implantation or 1 year after electronic health record data availability. CHA 2 DS 2 -VASc score was assessed using electronic health record data before the index date. Maximum daily AF burden (no AF, 6 minutes–23.5 hours, and >23.5 hours) was assessed over the 6 months before the index date. SSE rates were computed after the index date. Results: Among 21 768 nonanticoagulated patients with cardiovascular implantable electronic devices (age, 68.6±12.7 years; 63% male), both increasing AF duration ( P <0.001) and increasing CHA 2 DS 2 -VASc score ( P <0.001) were significantly associated with annualized risk of SSE. SSE rates were low in patients with a CHA 2 DS 2 -VASc score of 0 to 1 regardless of device-detected AF duration. However, stroke risk crossed an actionable threshold defined as >1%/y in patients with a CHA 2 DS 2 -VASc score of 2 with >23.5 hours of AF, those with a CHA 2 DS 2 -VASc score of 3 to 4 with >6 minutes of AF, and patients with a CHA 2 DS 2 -VASc score ≥5 even with no AF. Conclusions: There is an interaction between AF duration and CHA 2 DS 2 -VASc score that can further risk-stratify patients with AF for SSE and may be useful in guiding anticoagulation therapy.

The difference of burden of ectopic beats in different types of atrial fibrillation and the effect of atrial fibrillation type on stroke risk in a prospective cohort of patients with atrial fibrillation (CODE-AF registry)

“…In the KP-RHYTHM Study, a greater burden of AF identified using a noninvasive, 14-day continuous patch devices monitoring is associated with a higher risk of ischemic stroke and thromboembolism in adults with paroxysmal AF 35 . A recent study from Kaplan et al has shown that the duration of AF and CHA 2 DS 2 -VASc scores are both important components in assessing stroke risk and therefore in determining when OAC therapy should be initiated 36 .…”

Atrial Fibrillation Ablation Success Defined by Duration of Recurrence on Cardiac Implantable Electronic Devices

“…While improvement in symptoms is the major clinical endpoint of ablation for AF, AF duration and burden appear to correlate with risk of stroke 15,16,18,27 , raising the hypothesis that strategies that reduce AF burden could potentially mitigate stroke risk, even in the absence of completely eliminating recurrent AF. This hypothesis, along with the data that AF burden reduction may similarly reduce heart failure hospitalization and mortality was tested in a recent random-effect model meta-analysis of large databases, registries and a single randomized control trial (the CABANA trial 1 ) with a total of 241,372 patients.…”

“…Furthermore, some authors have suggested that a reduction in AF burden may be a more objective endpoint rather than a binary outcome of recurrence as a measure of success 14 . This may be even more important given emerging data correlating AF duration and burden with risk of stroke 15,16,17,18 , a risk which may be attenuated in part by AF ablation 19 . The present exploratory analysis used a large de-identified electronic health record (EHR) dataset to assess how variations in defining AF recurrence and frequency and duration of monitoring influence an assessment of treatment success or failure.…”

Incidence and Risk Assessment for Atrial Fibrillation at 5 Years: Hypertensive Diabetic Cohort

“…Regarding the usefulness of risk scales [31,[36][37][38], the inclusion of new prognostic variables, their accessibility from primary care, their prognostic time, and their cost-effectiveness [6] in relation to the main objective should be considered: AF detection vs. prevention ictus. Our study did not use echocardiographic data [23,39] but shows specificities by gender.…”