Clinical risk prediction scores for stroke and bleeding showed modest predictive performance (lower c-statistics) among adults with atrial fibrillation and advanced chronic kidney disease.
Cohort (n=134,560)
Yes
Do standard clinical risk prediction scores accurately predict ischemic stroke and intracranial bleeding in adults with atrial fibrillation across different levels of kidney function?
Standard clinical risk scores for stroke and bleeding have only modest predictive accuracy in patients with atrial fibrillation and chronic kidney disease, highlighting the need for better risk stratification tools in this population.
RATIONALE & OBJECTIVE: The performance of clinical risk prediction scores for ischemic stroke and bleeding are not well established in those with CKD and atrial fibrillation (AF). We aimed to evaluate the performance of three risk scores for ischemic stroke and intracranial bleeding in patients across a broad range of kidney function. STUDY DESIGN: Retrospective study. SETTING & PARTICIPANTS: The study included two community-based cohorts of adults with incident AF (Kaiser Permanente and Ontario, Canada). EXPOSURE: Baseline estimated glomerular filtration rate (eGFR) was calculated using outpatient serum creatinine measures, excluding those with a kidney transplant or on dialysis. OUTCOMES: Three risk scores for ischemic stroke (ATRIA, CHA ANALYTICAL APPROACH: C-statistics were calculated and calibration plots generated within eGFR strata. RESULTS: There were 101,360 adults with incident AF in the Kaiser Permanente cohort and 33,200 adults with incident AF in the Ontario cohort. Mean risk scores for stroke and bleeding were higher with lower eGFR across all four measures. The c-statistics for the stroke prediction scores were lower in those with an eGFR <60 mL/min/1.73 m LIMITATIONS: Observational study. CONCLUSIONS: Performance of clinically used stroke and bleeding risk prediction scores was modest among those with CKD, particularly at advanced CKD. More accurate risk scores are needed to improve decision-making. PLAIN-LANGUAGE SUMMARY: This retrospective analysis evaluated the predictive accuracy of standard clinical risk scores for ischemic stroke (ATRIA, CHA
Bansal et al. (Fri,) conducted a cohort in Atrial Fibrillation and Chronic Kidney Disease (n=134,560). Baseline estimated glomerular filtration rate (eGFR) was evaluated on Performance of risk scores for ischemic stroke and intracranial bleeding (c-statistics). Clinical risk prediction scores for stroke and bleeding showed modest predictive performance (lower c-statistics) among adults with atrial fibrillation and advanced chronic kidney disease.