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CHADS2 risk score assigns over one-third of stroke patients to low or intermediate stroke risk
Date:8/31/2013

In contrast, a CHA2DS2-VASc score of 0 identifies a subgroup of patients with very low stroke risk unlikely to benefit from anticoagulation treatment.

Professor Nabauer said: "AF is the most frequent cardiac arrhythmia requiring hospitalisation and has a 1-2% prevalence in the general population. AF is associated with a significant risk of stroke with frequently disabling consequences. While oral anticoagulation is very effective in preventing ischaemic strokes in AF, it increases bleeding risk. Identification of patients with low risk of stroke not requiring oral anticoagulation is important to maximise anticoagulation benefit while avoiding the cost, hassle, and bleeding risk of oral anticoagulation."

The present study tested stroke risk stratification schemes for identifying patients with very low stroke risk who may not benefit from oral anticoagulation. The analysis was based on the prospective registry of the German Competence Network on Atrial Fibrillation (AFNET) which started in 2004-2006 and includes 9,575 patients with AF. Follow-up was for a mean of 5.1 years, and stroke events were adjudicated by a critical event committee.

On enrolment, 47.7% of patients with non-valvular AF (n=8,847) in the AFNET registry were assigned a CHADS2 score of 0 (16.2%) or 1 (31.5%) indicating that oral anticoagulation was not definitively recommended. Surprisingly, 35.8% (145 out of 405) of strokes and other thromboembolic events (transient ischaemic attack, systemic embolism) during follow-up occurred in this patient subgroup initially classified by CHADS2 to have low or intermediate stroke risk (CHADS2=0: 45, CHADS2=1: 100 events).

Professor Nabauer said: "This finding suggests that classes CHADS2 0 and 1 contain subgroups of patients with significant stroke risk that may be identified by refined stroke risk stratification."

The CHA2DS2-VASc score, which adds age 65-74 years, vascular disease and female gender as stroke r
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Contact: Celine Colas
press@escardio.org
44-773-005-7146
European Society of Cardiology
Source:Eurekalert

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