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Dynamic Changes of CHA2DS2-VASc Score and the Risk of Ischaemic Stroke in Asian Patients with Atrial Fibrillation: A Nationwide Cohort Study

Other Titles
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Authors
 Minjae Yoon  ;  Pil-Sung Yang  ;  Eunsun Jang  ;  Hee Tae Yu  ;  Tae-Hoon Kim  ;  Jae-Sun Uhm  ;  Jong-Youn Kim  ;  Hui-Nam Pak  ;  Moon-Hyoung Lee  ;  Gregory Y H Lip  ;  Boyoung Joung 
Citation
 Thrombosis and Haemostasis, Vol.118(7) : 1296-1304, 2018 
Journal Title
 Thrombosis and Haemostasis 
ISSN
 0340-6245 
Issue Date
2018
Abstract
BACKGROUND: Stroke risk in atrial fibrillation (AF) is often assessed at initial presentation, and risk stratification performed as a 'one off'. In validation studies of risk prediction, baseline values are often used to 'predict' events that occur many years later. Many clinical variables have 'dynamic' changes over time, as the patient is followed up. These dynamic changes in risk factors may increase the CHA2DS2-VASc score, stroke risk category and absolute ischaemic stroke rate. OBJECTIVE: This article evaluates the 'dynamic' changes of CHA2DS2-VASc variables and its effect on prediction of stroke risk. PATIENTS AND METHODS: From the Korea National Health Insurance Service database, a total of 167,262 oral anticoagulant-naive non-valvular AF patients aged >/= 18 years old were enrolled between January 1, 2002, and December 31, 2005. These patients were followed up until December 31, 2015. RESULTS: At baseline, the proportions of subjects categorized as 'low', 'intermediate' or 'high risk' by CHA2DS2-VASc score were 15.4, 10.6 and 74.0%, respectively. Mean CHA2DS2-VASc score increased annually by 0.14, particularly due to age and hypertension. During follow-up of 10 years, 46.6% of 'low-risk' patients and 72.0% of 'intermediate risk' patients were re-classified to higher stroke risk categories. Among the original 'low-risk' patients, annual ischaemic stroke rates were significantly higher in the re-classified 'intermediate' (1.17 per 100 person-years, p < 0.001) or re-classified 'high-risk' groups (1.44 per 100 person-years, p = 0.048) than consistently 'low-risk' group (0.29 per 100 person-years). The most recent CHA2DS2-VASc score and the score change with the longest follow-up had the best prediction for ischaemic stroke. CONCLUSION: In AF patients, stroke risk as assessed by the CHA2DS2-VASc score is dynamic and changes over time. Rates of ischaemic stroke increased when patients accumulated risk factors, and were re-classified into higher CHA2DS2-VASc score categories. Stroke risk assessment is needed at every patient contact, as accumulation of risk factors with increasing CHA2DS2-VASc score translates to greater stroke risks over time.
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/162668
Full Text
https://www.thieme-connect.de/DOI/DOI?10.1055/s-0038-1651482
DOI
10.1055/s-0038-1651482
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) ORCID logo https://orcid.org/0000-0003-4200-3456
박희남(Pak, Hui Nam) ORCID logo https://orcid.org/0000-0002-3256-3620
엄재선(Uhm, Jae Sun) ORCID logo https://orcid.org/0000-0002-1611-8172
유희태(Yu, Hee Tae) ORCID logo https://orcid.org/0000-0002-6835-4759
이문형(Lee, Moon Hyoung) ORCID logo https://orcid.org/0000-0002-7268-0741
장은선(Jang, Eunsun) ORCID logo https://orcid.org/0000-0001-6991-4765
정보영(Joung, Bo Young) ORCID logo https://orcid.org/0000-0001-9036-7225
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