The risk for stroke based on the CHA2DS2-VASc score increased more in men, African Americans and Hispanic/Latinos with atrial fibrillation compared with women, Caucasians and Asians, according to a research letter published in the Journal of the American College of Cardiology.
Adam J. Russak, MD, resident physician of internal medicine at Mount Sinai Icahn School of Medicine, and colleagues analyzed data from 5,626 patients (mean age, 66 years; 58.5% men; 51.2% Caucasian; 26.8% African American; 17.1% Hispanic/Latino; 4.9% Asian) with newly diagnosed AF between 2003 and 2017. Men had a CHA2DS2-VASc score of 0 and women had a score of 1 when diagnosed with AF. The CHA2DS2-VASc score was measured with a validated algorithm at each patient visit after the AF diagnosis.
Within 1 year, the CHA2DS2-VASc score increased in 27.4% of patients in the study. During a median follow-up of 2.01 years, the median CHA2DS2-VASc score increase was 36%. Scores during follow-up increased in 43.6% of African Americans and 38.7% of Hispanic/Latinos.
In a multivariable Cox proportional hazards regression model, compared with Caucasians, a significantly higher risk for a CHA2DS2-VASc score increase was seen in African Americans (HR = 1.44; 95% CI, 1.33-1.57); Asians (HR = 1.21; 95% CI, 1.02-1.43) and Hispanic/Latinos (HR = 1.17; 95% CI, 1.06-1.3). This increased risk was also seen in men compared with women (HR = 1.2; 95% CI, 1.12-1.29).
Researchers also conducted a separate analysis for score increased from less than 1 to 2 in men and less than 2 to 3 in women. Within 1 year, 24.5% of patients were recommended for anticoagulation, which increased to 34.4% at 2 years. Similar incidence ratios were seen when stratified by sex and race/ethnicity.
“Our findings affirm the need for frequent stroke risk reassessment in AF patients, particularly for men and for patients of African American or Hispanic ethnicity,” Russak and colleagues wrote. “Clinicians should consider these factors when determining optimal risk reassessment intervals for their AF patients.” – by Darlene Dobkowski
Disclosures: Russak reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.