MedStar Authors catalog › Details for: Does CHA2DS2-VASc improve stroke risk stratification in postmenopausal women with atrial fibrillation?.
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Does CHA2DS2-VASc improve stroke risk stratification in postmenopausal women with atrial fibrillation?.

by Shara, Nawar M.
Citation: American Journal of Medicine. 126(12):1143.e1-8, 2013 Dec..Journal: The American journal of medicine.ISSN: 0002-9343.Full author list: Abraham JM; Larson J; Chung MK; Curtis AB; Lakshminarayan K; Newman JD; Perez M; Rexrode K; Shara NM; Solomon AJ; Stefanick ML; Torner JC; Wilkoff BL; Wassertheil-Smoller S.UI/PMID: 24139523.Subject(s): Aged | *Atrial Fibrillation/co [Complications] | Cardiovascular Diseases/co [Complications] | Cohort Studies | Diabetes Complications/co [Complications] | Female | Heart Failure/co [Complications] | Humans | Middle Aged | Multivariate Analysis | Postmenopause | Proportional Hazards Models | Research Design | Risk Factors | *Stroke/et [Etiology] | Women's HealthInstitution(s): MedStar Health Research InstituteActivity type: Journal Article.Medline article type(s): Journal Article | Research Support, U.S. Gov't, P.H.SOnline resources: Click here to access online Digital Object Identifier: http://dx.doi.org/10.1016/j.amjmed.2013.05.023 (Click here) Abbreviated citation: Am J Med. 126(12):1143.e1-8, 2013 Dec.Local Holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - present.Abstract: BACKGROUND: Risk stratification of atrial fibrillation patients with a congestive heart failure (C), hypertension (H), age > 75 (A), diabetes (D), stroke or transient ischemic attack (TIA) (S2) (CHADS2) score of <2 remains imprecise, particularly in women. Our objectives were to validate the CHADS2 and congestive heart failure (C), hypertension (H), age > 75 (A2), diabetes (D), stroke, TIA or prior thromboembolic disease (S2)- vascular disease (V), age 65-74 (A), female gender (S) (CHA2DS2-VASc) stroke risk scores in a healthy cohort of American women with atrial fibrillation and to determine whether CHA2DS2-VASc further risk-stratifies individuals with a CHADS2 score of <2.Abstract: METHODS: We identified a cohort of 5981 women with atrial fibrillation not on warfarin at baseline (mean age 65.9 + 7.2 years) enrolled in the Women's Health Initiative and followed for a median of 11.8 years. Univariate and multivariate proportional hazards analyses were used to examine these 2 risk scores, with main outcome measures being annualized event rates of ischemic stroke or transient ischemic attack stratified by risk score.Abstract: RESULTS: Annualized stroke/transient ischemic attack rates ranged from 0.36% to 2.43% with increasing CHADS2 score (0-4+) (hazard ratio [HR] 1.57; 95% confidence interval [CI], 1.45-1.71 for each 1-point increase) and 0.20%-2.02% with increasing CHA2DS2-VASc score (1-6+) (HR 1.50; 95% CI, 1.41-1.60 for each 1-point increase). CHA2DS2-VASc had a higher c statistic than CHADS2: 0.67 (95% CI, 0.65-0.69) versus 0.65 (95% CI, 0.62-0.67), P <.01. For CHADS2 scores <2, stroke risk almost doubled with every additional CHA2DS2-VASc point.Abstract: CONCLUSIONS: Although both CHADS2, and CHA2DS2-VASc are predictive of stroke risk in postmenopausal women with atrial fibrillation, CHA2DS2-VASc further risk-stratifies patients with a CHADS2 score <2. Copyright 2013 Elsevier Inc. All rights reserved.

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