Back to Search Start Over

Changes in CHA 2 DS 2 -VASc score and risk of ischemic stroke among patients with atrial fibrillation.

Authors :
Tsiartas E
Samaras A
Papazoglou AS
Kartas A
Moysidis DV
Gemousakakis E
Kamzolas O
Bekiaridou A
Doundoulakis I
Tzikas A
Giannakoulas G
Source :
Heart and vessels [Heart Vessels] 2023 Oct; Vol. 38 (10), pp. 1267-1276. Date of Electronic Publication: 2023 Jun 13.
Publication Year :
2023

Abstract

Aims: The CHA <subscript>2</subscript> DS <subscript>2</subscript> -VASc score is fundamental to stroke risk assessment in atrial fibrillation. However, stroke-related risk factors can be modified later in life. This study aimed to assess the association of changes in CHA <subscript>2</subscript> DS <subscript>2</subscript> -VASc score over time (Delta CHA <subscript>2</subscript> DS <subscript>2</subscript> -VASc score) with the risk of ischemic stroke.<br />Materials and Methods: This is an observational analysis of 1127 atrial fibrillation patients previously enrolled in the MISOAC-AF trial. After a median 2.6-year follow-up period, baseline and follow-up CHA <subscript>2</subscript> DS <subscript>2</subscript> -VASc scores were used to extract the Delta CHA <subscript>2</subscript> DS <subscript>2</subscript> -VASc score. The stroke predicting accuracies of the baseline, follow-up, and Delta CHA <subscript>2</subscript> DS <subscript>2</subscript> -VASc scores were assessed through regression analyses.<br />Results: The mean baseline, follow-up, and Delta CHA <subscript>2</subscript> DS <subscript>2</subscript> -VASc scores were 4.2, 4.8, and 0.6 respectively. Ischemic stroke occurred in 54 (4.4%) patients, of which 83.3% had a Delta CHA <subscript>2</subscript> DS <subscript>2</subscript> -VASc score ≥1, contrary to 40.1% of the stroke-free group. The stroke risk per 1-point increase of the CHA <subscript>2</subscript> DS <subscript>2</subscript> -VASc score was not significantly associated with the baseline score (aHR=1.14; 95%CI: 0.93-1.41; p=0.201), whereas a significant association was observed with the follow-up (aHR=2.58; 95% CI: 2.07-3.21; p<0.001) and Delta (aHR=4.56; 95%CI: 3.50-5.94; p<0.001) scores. C-index assessment indicated that follow-up and Delta CHA <subscript>2</subscript> DS <subscript>2</subscript> -VASc scores were more potent predictors of ischemic stroke compared to baseline.<br />Conclusion: In atrial fibrillation patients, changes in CHA <subscript>2</subscript> DS <subscript>2</subscript> -VASc score over time were associated with the incidence of stroke. The improved predictability of follow-up and Delta CHA <subscript>2</subscript> DS <subscript>2</subscript> -VASc scores indicates that stroke risk is not a static parameter.<br />Trial Registration: This is an observational, post-hoc analysis of the MISOAC-AF randomized controlled trial, registered on ClinicalTrials.gov (identifier: NCT02941978; registered: October 21, 2016).<br /> (© 2023. The Author(s).)

Subjects

Subjects :
Humans
Risk Factors
Risk Assessment
Atrial Fibrillation complications
Atrial Fibrillation diagnosis
Atrial Fibrillation epidemiology
Ischemic Stroke complications
Stroke epidemiology
Stroke etiology

Details

Language :
English
ISSN :
1615-2573
Volume :
38
Issue :
10
Database :
MEDLINE
Journal :
Heart and vessels
Publication Type :
Academic Journal
Accession number :
37311823
Full Text :
https://doi.org/10.1007/s00380-023-02278-1
Full Text Access
View/download PDF

Tools

Authors Abstract Subjects Details