In the Journals

Risk for stroke should be reassessed annually in patients with atrial fibrillation

Reassessing CHA2DS2-VASc scores for stroke risk annually may improve risk predictions and inform oral anticoagulant prescribing in patients with atrial fibrillation, according to findings published in Annals of Internal Medicine.

“International guidelines suggest that oral anticoagulants can be omitted for patients with atrial fibrillation without a CHA2DS2-VASc score greater than 0 (men) or 1 (women),” Tze-Fan Chao, MD, from Taipei Veterans General Hospital and National Yang-Ming University, Taiwan, and colleagues wrote. “However, stroke risk is not static among patients with atrial fibrillation, and about 90% develop at least one new risk factor before presentation with ischemic stroke.”

“Therefore, patients with atrial fibrillation who have a CHA2DS2-VASc score of 0 (men) or 1 (women) at baseline and acquire more comorbidities over time would no longer be ‘low-risk,’” they added.

Chao and colleagues examined how often CHA2DS2-VASc score for stroke risk increased to at least 1 in men or 2 in women among patients with newly diagnosed atrial fibrillation and a baseline score of 0 in men or 1 in women.

The researchers used the Taiwan National Health Insurance Research Database to identify 14,606 patients (mean age, 47.8 years) with newly diagnosed atrial fibrillation and a CHA2DS2-VASc score of 0 (8,745 men) or 1 (5,861 women) who did not receive antiplatelets or oral anticoagulants between Jan. 1, 1997 and Dec. 31, 2010. If the database did not indicate a diagnosis from Jan. 1, 1996 to the date of diagnosis of incident atrial fibrillation, new onset of atrial fibrillation was assumed.

During follow-up (mean, 3.24 years), at least one new risk factor occurred in 36.3% of patients (n = 5,301).

An increase in CHA2DS2-VASc score to 1 or higher occurred in 16.1% (95% CI, 15.2-16.9) of men at 1 year, 24.5% (95% CI, 23.5-25.5) at 2 years and 49.1% (95% CI, 47.8-50.3) of men at 7 years. An increase in CHA2DS2-VASc score to 2 or higher occurred in 16.2% (95% CI, 15.1-17.1) of women at 1 year, 24.9% (95% CI, 23.7-26.1) of women at 2 years and 49.9% (95% CI, 48.4-51.4) of women at 7 years.

“We propose that CHA2DS2-VASc scores should be reassessed at least annually in patients with atrial fibrillation so that oral anticoagulants can be prescribed in a timely manner for stroke prevention,” Chao and colleagues concluded. – by Alaina Tedesco

 

Disclosures: Chao reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.

Reassessing CHA2DS2-VASc scores for stroke risk annually may improve risk predictions and inform oral anticoagulant prescribing in patients with atrial fibrillation, according to findings published in Annals of Internal Medicine.

“International guidelines suggest that oral anticoagulants can be omitted for patients with atrial fibrillation without a CHA2DS2-VASc score greater than 0 (men) or 1 (women),” Tze-Fan Chao, MD, from Taipei Veterans General Hospital and National Yang-Ming University, Taiwan, and colleagues wrote. “However, stroke risk is not static among patients with atrial fibrillation, and about 90% develop at least one new risk factor before presentation with ischemic stroke.”

“Therefore, patients with atrial fibrillation who have a CHA2DS2-VASc score of 0 (men) or 1 (women) at baseline and acquire more comorbidities over time would no longer be ‘low-risk,’” they added.

Chao and colleagues examined how often CHA2DS2-VASc score for stroke risk increased to at least 1 in men or 2 in women among patients with newly diagnosed atrial fibrillation and a baseline score of 0 in men or 1 in women.

The researchers used the Taiwan National Health Insurance Research Database to identify 14,606 patients (mean age, 47.8 years) with newly diagnosed atrial fibrillation and a CHA2DS2-VASc score of 0 (8,745 men) or 1 (5,861 women) who did not receive antiplatelets or oral anticoagulants between Jan. 1, 1997 and Dec. 31, 2010. If the database did not indicate a diagnosis from Jan. 1, 1996 to the date of diagnosis of incident atrial fibrillation, new onset of atrial fibrillation was assumed.

During follow-up (mean, 3.24 years), at least one new risk factor occurred in 36.3% of patients (n = 5,301).

An increase in CHA2DS2-VASc score to 1 or higher occurred in 16.1% (95% CI, 15.2-16.9) of men at 1 year, 24.5% (95% CI, 23.5-25.5) at 2 years and 49.1% (95% CI, 47.8-50.3) of men at 7 years. An increase in CHA2DS2-VASc score to 2 or higher occurred in 16.2% (95% CI, 15.1-17.1) of women at 1 year, 24.9% (95% CI, 23.7-26.1) of women at 2 years and 49.9% (95% CI, 48.4-51.4) of women at 7 years.

“We propose that CHA2DS2-VASc scores should be reassessed at least annually in patients with atrial fibrillation so that oral anticoagulants can be prescribed in a timely manner for stroke prevention,” Chao and colleagues concluded. – by Alaina Tedesco

 

Disclosures: Chao reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.