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Does CHA2DS2-VASc improve stroke risk stratification in postmenopausal women with atrial fibrillation?.

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Citation: American Journal of Medicine. 126(12):1143.e1-8, 2013 Dec.PMID: 24139523Institution: MedStar Health Research InstituteForm of publication: Journal ArticleMedline article type(s): Journal Article | Research Support, U.S. Gov't, P.H.S.Subject headings: *Atrial Fibrillation/co [Complications] | *Stroke/et [Etiology] | Aged | 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 | Women's HealthYear: 2013 Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - presentISSN:

0002-9343

Name of journal: The American journal of medicineAbstract: 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.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.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.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.All authors: Abraham JM, Chung MK, Curtis AB, Lakshminarayan K, Larson J, Newman JD, Perez M, Rexrode K, Shara NM, Solomon AJ, Stefanick ML, Torner JC, Wassertheil-Smoller S, Wilkoff BLFiscal year: FY2014Digital Object Identifier:

http://dx.doi.org/10.1016/j.amjmed.2013.05.023

Date added to catalog: 2014-02-24

Holdings ( 1 )
Title notes ( 6 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	24139523	Available		24139523

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - present

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.

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.

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.

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.

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