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Addition of black ethnicity to CHA2DS2-VASc score improves stroke prediction
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For patients with atrial fibrillation, adding black ethnicity to CHA2DS2-VASc score improves stroke prediction, according to recent data.
Rajesh Kabra, MD, from the division of cardiology, department of internal medicine at the University of Tennessee Health Science Center, Memphis, and colleagues revised the CHA2DS2-VASc score to include black ethnicity and recalculated risk for stroke among patients with newly diagnosed AF. Patient data came from Medicare claims between January 2010 and December 2012. The primary outcome was stroke.
Overall, 460,417 patients with AF were identified, and 31,702 (6.9%) were black. During a follow-up of 18 months, 16,703 stroke events occurred, according to the findings. Black patients had the highest rate of stroke (38 per 1,000 patient-years), with Native American (28.7 per 1,000 patient-years) and Hispanic patients (27.8 per 1,000 patient-years) having the next-highest rates. The rate for white patients was 23 per 1,000 patient-years.
The relative HR for stroke was 1.3 for black patients compared with white patients in patients who did not receive anticoagulants and 1.47 for black patients compared with white patients among those prescribed anticoagulants.
The new CHA2DS2-VASc-R model had a C-statistic of 0.61 (95% CI, 0.6-0.62) compared with a C-statistic of 0.6 (95% CI, 0.59-0.61) for the original CHA2DS2-VASc score. The researchers calculated the net reclassification improvement as 7.6% (P < .001) and determined the integrated discrimination improvement was 0.012 for black patients.
“We found that compared with the [seven] existing variables in the CHA2DS2-VASc score, African-American ethnicity was a stronger predictor than [HF], hypertension, diabetes mellitus, and history of vascular disease,” Kabra and colleagues wrote. “Only prior history of stroke, age 75 years or older, and female sex were more important than African-American ethnicity in prediction of stroke in this population.”
Christopher B. Granger, MD, and Kevin L. Thomas, MD, from Duke Clinical Research Institute, Duke University, wrote in a related editorial that “Understanding how black race should impact treatment decisions requires sufficient numbers of black patients in trials and registries that test and evaluate new therapies, something that has not been accomplished to date.
“Kabra [and colleagues] present a provocative and strong case that black race is an important factor when assessing stroke risk in patients with AF,” Granger and Thomas wrote. “Most important, these findings call on the medical community to investigate the role of race in understanding AF, its consequences, and optimal treatment for individual patients.”– by Tracey Romero
Disclosure: The researchers report no relevant financial disclosures. Granger reports consulting for Armetheon, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, Daiichi-Sankyo, Gilead, GlaxoSmithKline, Hoffman-La Roche, Janssen, The Medicines Company, Medtronic, Medtronic Foundation, Novartis, Sanofi and Takeda. Thomas reports consulting for Bristol-Myers Squibb, Janssen and Pfizer.
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