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CHA2DS2-VASc Score for Identifying Truly Low-Risk Atrial Fibrillation for Stroke: A Korean Nationwide Cohort Study

Authors
 Tae-Hoon Kim  ;  Pil-Sung Yang  ;  Daehoon Kim  ;  Hee Tae Yu  ;  Jae-Sun Uhm  ;  Jong-Youn Kim  ;  Hui-Nam Pak  ;  Moon-Hyoung Lee  ;  Boyoung Joung  ;  Gregory Y.H. Lip 
Citation
 Stroke, Vol.48(11) : 2984-2990, 2017 
Journal Title
 Stroke 
ISSN
 0039-2499 
Issue Date
2017
MeSH
Administration, Oral ; Adult ; Aged ; Aged, 80 and over ; Anticoagulants/administration & dosage* ; Atrial Fibrillation*/complications ; Atrial Fibrillation*/drug therapy ; Atrial Fibrillation*/epidemiology ; Atrial Fibrillation*/physiopathology ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Republic of Korea/epidemiology ; Risk Factors ; Stroke*/epidemiology ; Stroke*/etiology ; Stroke*/physiopathology ; Stroke*/prevention & control
Keywords
anticoagulants ; atrial fibrillation ; follow-up studies ; risk ; stroke
Abstract
BACKGROUND AND PURPOSE: As the threshold of stroke risk for initiating oral anticoagulants is lowered after the introduction of the nonvitamin K antagonist oral anticoagulants, the focus of stroke prevention in patients with nonvalvular atrial fibrillation has shifted away from predicting high-risk patients toward initially identifying patients with a truly low risk of ischemic stroke, who do not need antithrombotic therapy. We tested the predictive ability of the congestive heart failure, hypertension, age ≥75, diabetes mellitus, prior stroke or transient ischemic attack (doubled; CHADS2), congestive heart failure, hypertension, age ≥75 (doubled), diabetes mellitus, prior stroke or transient ischemic attack (doubled), vascular disease, age 65 to 74, female (CHA2DS2-VASc), and Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) risk stratification schemes in oral anticoagulants naive patients with atrial fibrillation in a Korean nationwide sample cohort. METHODS: From January 2002 to December 2008, a total of 5855 oral anticoagulant naive patients with nonvalvular atrial fibrillation aged ≥20 years were enrolled from Korea National Health Insurance Service-Sample Cohort database and were followed-up until December 2013. RESULTS: At baseline, the proportions categorized as low risk using CHADS2, CHA2DS2-VASc, and ATRIA risk stratification schemes were 1049 (17.9%), 860 (14.7%), and 3280 (56.0%), respectively. During follow-up, the low-risk category using CHADS2, CHA2DS2-VASc, and ATRIA scores was retained in 811 (13.9%), 667 (11.4%), and 2729 (46.6%) patients, respectively. Rates of ischemic stroke (100 person-years) in the low risk categories of CHADS2, CHA2DS2-VASc, and ATRIA scores were 0.42, 0.26, and 1.43, respectively. CHA2DS2-VASc had the best sensitivity (98.8% versus 85.7% in CHADS2 and 74.8% in ATRIA) and negative predictive value (98.8% versus 95.3% for CHADS2 and 93.7% for ATRIA) for the prediction of stroke incidence and was best for the prediction of the absence of ischemic stroke during 5 years of follow-up (odds ratio, 16.4 [95% confidence interval, 8.8-30.8]). CONCLUSIONS: The CHA2DS2-VASc score shows good performance in defining truly low-risk Asian patients with atrial fibrillation for stroke compared with CHADS2 and ATRIA scores.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/161372
DOI
10.1161/STROKEAHA.117.018551
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
Yonsei Authors
김종윤(Kim, Jong Youn) ; 김태훈(Kim, Tae-Hoon) ; 박희남(Pak, Hui Nam) ; 양필성(Yang, Pil Sung) ; 엄재선(Uhm, Jae Sun) ; 유희태(Yu, Hee Tae) ; 이문형(Lee, Moon Hyoung) ; 정보영(Joung, Bo Young)
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Full Text
http://stroke.ahajournals.org/content/48/11/2984.long
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