Usefulness of CHA2DS2-VASc Score to Predict Stroke Risk Independent of Atrial Fibrillation

Anne Gulbech Ording*, Erzsébet Horváth-Puhó, P. Prandoni, Michelle Zippora Leisner, Dóra Körmendiné Farkas, Flemming Hald Steffensen, Morten Olsen, Henrik Toft Sørensen, Morten Schmidt

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Resumé

The CHA2DS2-VASc score is used to predict stroke risk among patients with atrial fibrillation (AF). We examined whether a CHA2DS2-VASc score predicts stroke risk among individuals without hospital-diagnosed AF and quantified the magnitude of the association in comparison to AF patients. We used data from population-based medical registries (1995 to 2005) covering all Danish hospitals to identify patients diagnosed with AF (n = 122,980). We matched ≤5 non-AF individuals (n = 612,723) to each AF patient on the individual risk factors included in the CHA2DS2-VASc score. We calculated 10-year absolute risk of ischemic and all-cause stroke in AF and non-AF individuals and compared the stroke risk between cohorts within strata of CHA2DS2-VASc scores using Cox regression. The 10-year risk of ischemic/all-cause stroke was 4.4%/8.8% among non-AF individuals and 6.2%/12% in AF patients, corresponding to a risk difference of 1.8% for ischemic stroke and 3.3% for all-cause stroke. In both cohorts, the stroke risk correlated with increasing CHA2DS2-VASc scores. However, in individuals with CHA2DS2-VASc scores ≥5 who were <75 years or male, the absolute risk of ischemic stroke in individuals without AF exceeded the risk in AF patients. In the same subgroups, the hazard ratio approached unity. Similar results were observed for all-cause stroke. The CHA2DS2-VASc score was associated with 10-year stroke risk also among individuals without hospital-diagnosed AF. In conclusion, primary prophylactic anticoagulation therapy may be relevant in male and younger non-AF individuals with CHA2DS2-VASc scores ≥5. These findings should be confirmed in clinical trials.

OriginalsprogEngelsk
TidsskriftAmerican Journal of Cardiology
Vol/bind124
Udgave nummer7
Sider (fra-til)1059-1063
ISSN0002-9149
DOI
StatusUdgivet - 1. okt. 2019

Fingeraftryk

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Citer dette

Ording, A. G., Horváth-Puhó, E., Prandoni, P., Leisner, M. Z., Farkas, D. K., Steffensen, F. H., ... Schmidt, M. (2019). Usefulness of CHA2DS2-VASc Score to Predict Stroke Risk Independent of Atrial Fibrillation. American Journal of Cardiology, 124(7), 1059-1063. https://doi.org/10.1016/j.amjcard.2019.06.028
Ording, Anne Gulbech ; Horváth-Puhó, Erzsébet ; Prandoni, P. ; Leisner, Michelle Zippora ; Farkas, Dóra Körmendiné ; Steffensen, Flemming Hald ; Olsen, Morten ; Sørensen, Henrik Toft ; Schmidt, Morten. / Usefulness of CHA2DS2-VASc Score to Predict Stroke Risk Independent of Atrial Fibrillation. I: American Journal of Cardiology. 2019 ; Bind 124, Nr. 7. s. 1059-1063.
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abstract = "The CHA2DS2-VASc score is used to predict stroke risk among patients with atrial fibrillation (AF). We examined whether a CHA2DS2-VASc score predicts stroke risk among individuals without hospital-diagnosed AF and quantified the magnitude of the association in comparison to AF patients. We used data from population-based medical registries (1995 to 2005) covering all Danish hospitals to identify patients diagnosed with AF (n = 122,980). We matched ≤5 non-AF individuals (n = 612,723) to each AF patient on the individual risk factors included in the CHA2DS2-VASc score. We calculated 10-year absolute risk of ischemic and all-cause stroke in AF and non-AF individuals and compared the stroke risk between cohorts within strata of CHA2DS2-VASc scores using Cox regression. The 10-year risk of ischemic/all-cause stroke was 4.4{\%}/8.8{\%} among non-AF individuals and 6.2{\%}/12{\%} in AF patients, corresponding to a risk difference of 1.8{\%} for ischemic stroke and 3.3{\%} for all-cause stroke. In both cohorts, the stroke risk correlated with increasing CHA2DS2-VASc scores. However, in individuals with CHA2DS2-VASc scores ≥5 who were <75 years or male, the absolute risk of ischemic stroke in individuals without AF exceeded the risk in AF patients. In the same subgroups, the hazard ratio approached unity. Similar results were observed for all-cause stroke. The CHA2DS2-VASc score was associated with 10-year stroke risk also among individuals without hospital-diagnosed AF. In conclusion, primary prophylactic anticoagulation therapy may be relevant in male and younger non-AF individuals with CHA2DS2-VASc scores ≥5. These findings should be confirmed in clinical trials.",
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Ording, AG, Horváth-Puhó, E, Prandoni, P, Leisner, MZ, Farkas, DK, Steffensen, FH, Olsen, M, Sørensen, HT & Schmidt, M 2019, 'Usefulness of CHA2DS2-VASc Score to Predict Stroke Risk Independent of Atrial Fibrillation', American Journal of Cardiology, bind 124, nr. 7, s. 1059-1063. https://doi.org/10.1016/j.amjcard.2019.06.028

Usefulness of CHA2DS2-VASc Score to Predict Stroke Risk Independent of Atrial Fibrillation. / Ording, Anne Gulbech; Horváth-Puhó, Erzsébet; Prandoni, P.; Leisner, Michelle Zippora; Farkas, Dóra Körmendiné; Steffensen, Flemming Hald; Olsen, Morten; Sørensen, Henrik Toft; Schmidt, Morten.

I: American Journal of Cardiology, Bind 124, Nr. 7, 01.10.2019, s. 1059-1063.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Usefulness of CHA2DS2-VASc Score to Predict Stroke Risk Independent of Atrial Fibrillation

AU - Ording, Anne Gulbech

AU - Horváth-Puhó, Erzsébet

AU - Prandoni, P.

AU - Leisner, Michelle Zippora

AU - Farkas, Dóra Körmendiné

AU - Steffensen, Flemming Hald

AU - Olsen, Morten

AU - Sørensen, Henrik Toft

AU - Schmidt, Morten

PY - 2019/10/1

Y1 - 2019/10/1

N2 - The CHA2DS2-VASc score is used to predict stroke risk among patients with atrial fibrillation (AF). We examined whether a CHA2DS2-VASc score predicts stroke risk among individuals without hospital-diagnosed AF and quantified the magnitude of the association in comparison to AF patients. We used data from population-based medical registries (1995 to 2005) covering all Danish hospitals to identify patients diagnosed with AF (n = 122,980). We matched ≤5 non-AF individuals (n = 612,723) to each AF patient on the individual risk factors included in the CHA2DS2-VASc score. We calculated 10-year absolute risk of ischemic and all-cause stroke in AF and non-AF individuals and compared the stroke risk between cohorts within strata of CHA2DS2-VASc scores using Cox regression. The 10-year risk of ischemic/all-cause stroke was 4.4%/8.8% among non-AF individuals and 6.2%/12% in AF patients, corresponding to a risk difference of 1.8% for ischemic stroke and 3.3% for all-cause stroke. In both cohorts, the stroke risk correlated with increasing CHA2DS2-VASc scores. However, in individuals with CHA2DS2-VASc scores ≥5 who were <75 years or male, the absolute risk of ischemic stroke in individuals without AF exceeded the risk in AF patients. In the same subgroups, the hazard ratio approached unity. Similar results were observed for all-cause stroke. The CHA2DS2-VASc score was associated with 10-year stroke risk also among individuals without hospital-diagnosed AF. In conclusion, primary prophylactic anticoagulation therapy may be relevant in male and younger non-AF individuals with CHA2DS2-VASc scores ≥5. These findings should be confirmed in clinical trials.

AB - The CHA2DS2-VASc score is used to predict stroke risk among patients with atrial fibrillation (AF). We examined whether a CHA2DS2-VASc score predicts stroke risk among individuals without hospital-diagnosed AF and quantified the magnitude of the association in comparison to AF patients. We used data from population-based medical registries (1995 to 2005) covering all Danish hospitals to identify patients diagnosed with AF (n = 122,980). We matched ≤5 non-AF individuals (n = 612,723) to each AF patient on the individual risk factors included in the CHA2DS2-VASc score. We calculated 10-year absolute risk of ischemic and all-cause stroke in AF and non-AF individuals and compared the stroke risk between cohorts within strata of CHA2DS2-VASc scores using Cox regression. The 10-year risk of ischemic/all-cause stroke was 4.4%/8.8% among non-AF individuals and 6.2%/12% in AF patients, corresponding to a risk difference of 1.8% for ischemic stroke and 3.3% for all-cause stroke. In both cohorts, the stroke risk correlated with increasing CHA2DS2-VASc scores. However, in individuals with CHA2DS2-VASc scores ≥5 who were <75 years or male, the absolute risk of ischemic stroke in individuals without AF exceeded the risk in AF patients. In the same subgroups, the hazard ratio approached unity. Similar results were observed for all-cause stroke. The CHA2DS2-VASc score was associated with 10-year stroke risk also among individuals without hospital-diagnosed AF. In conclusion, primary prophylactic anticoagulation therapy may be relevant in male and younger non-AF individuals with CHA2DS2-VASc scores ≥5. These findings should be confirmed in clinical trials.

U2 - 10.1016/j.amjcard.2019.06.028

DO - 10.1016/j.amjcard.2019.06.028

M3 - Journal article

VL - 124

SP - 1059

EP - 1063

JO - The American Journal of Cardiology

JF - The American Journal of Cardiology

SN - 0002-9149

IS - 7

ER -

Ording AG, Horváth-Puhó E, Prandoni P, Leisner MZ, Farkas DK, Steffensen FH et al. Usefulness of CHA2DS2-VASc Score to Predict Stroke Risk Independent of Atrial Fibrillation. American Journal of Cardiology. 2019 okt 1;124(7):1059-1063. https://doi.org/10.1016/j.amjcard.2019.06.028