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Change in risk score strong predictor of stroke in AF
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Change in a stroke risk score used in patients with atrial fibrillation was a better predictor of stroke than baseline risk score, according to findings.
Researchers hypothesized that Delta CHA2DS2-VASc score, reflecting the change over time in the CHA2DS2-VASc score used to predict stroke risk in patients with AF, would be more predictive of ischemic stroke risk compared with baseline CHA2DS2-VASc score.
Tze-Fan Chao, MD, from the division of cardiology, department of medicine, Taipei Veterans General Hospital in Taiwan, and colleagues analyzed 31,039 patients with AF who did not take antiplatelet or anticoagulant drugs and who did not have comorbidities of the CHA2DS2-VASc score aside from age and sex. They compared the accuracy of baseline, follow-up and Delta CHA2DS2-VASc scores in prediction of ischemic stroke.
During 171,956 person-years of follow-up, there were 4,103 ischemic strokes, Chao and colleagues reported.
Mean baseline CHA2DS2-VASc score was 1.29, mean follow-up CHA2DS2-VASc score was 2.31 and mean Delta CHA2DS2-VASc score was 1.02.
CHA2DS2-VASc score did not change from baseline in 40.8% of patients.
Of those who had ischemic stroke, 89.4% had a Delta CHA2DS2-VASc score of at least 1, whereas of those who did not have ischemic stroke, 54.6% had a Delta CHA2DS2-VASc score of at least 1, according to the researchers.
Nearly two-thirds (64.4%) of those who had ischemic stroke acquired at least one new comorbidity, most commonly hypertension, between baseline and follow-up, Chao and colleagues wrote.
Area under the curve was higher for the Delta CHA2DS2-VASc score (0.742; 95% CI, 0.732-0.75) than for the baseline CHA2DS2-VASc score (0.578; 95% CI, 0.569-0.587) or the follow-up CHA2DS2-VASc score (0.729; 95% CI, 0.721-0.737).
The net reclassification index improved by 14.99% (95% CI, 13.98-15.99) for the Delta CHA2DS2-VASc score vs. the follow-up CHA2DS2-VASc score and by 16.41% (95% CI, 14.49-18.32) for the Delta CHA2DS2-VASc score vs. the baseline CHA2DS2-VASc score, according to the researchers.
“We clearly demonstrated that the CHA2DS2-VASc score is not static,” Chao and colleagues wrote. “Stroke risk in AF is dynamic due to increasing age and incident comorbidities.”
In a related editorial, Brian F. Gage, MD, MSc, from the department of medicine at Washington University in St. Louis, wrote: “Not only should further research validate the Delta CHA2DS2-VASc score, but it should also explain why a rise in CHA2DS2-VASc score has an especially high risk. One possible explanation is that when a new risk factor develops, it is also uncontrolled.” – by Erik Swain
Disclosures: One author reports he consults and/or speaks for Bayer, Biotronik, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, Daiichi Sankyo, Janssen, Medtronic, Microlife and Roche. The other authors and Gage report no relevant financial disclosures.
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