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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

 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 
 THROMBOSIS AND HAEMOSTASIS, Vol.118(7) : 1296-1304, 2018 
Journal Title
Issue Date
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.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jong Youn(김종윤) ORCID logo https://orcid.org/0000-0001-7040-8771
Kim, Tae-Hoon(김태훈) ORCID logo https://orcid.org/0000-0003-4200-3456
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Yu, Hee Tae(유희태) ORCID logo https://orcid.org/0000-0002-6835-4759
Lee, Moon-Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Jang, Eunsun(장은선) ORCID logo https://orcid.org/0000-0001-6991-4765
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
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