Stroke Risk Scores as Predictors of Severe Outcomes in Atrial Fibrillation: A Comprehensive Review

Background: Atrial fibrillation (AF) is the most frequent sustained arrhythmia. It increases the risk of stroke, heart failure, death, hospitalizations, and costs. Area of uncertainty: Several scores were introduced to stratify the stroke risk and need for anticoagulation in patients (pts) with AF . CHA 2 DS 2 -VASc, the most frequently used score, as well as other stroke risk scores have been additionally applied to estimate outcomes for different other conditions, with inhomogeneous results. To date, there has been no consensus regarding the usefulness of these scores to estimate outcomes outside of thromboembolic risk assessment, and their value in estimating different end-point outcomes is still a subject of debate. We conducted this review to investigate whether the stroke risk scores' utility can be extended for the prediction of other severe outcomes in pts with AF. Data sources: We searched PubMed database and included studies that stratified the outcome of pts with AF by different stroke risk scores. We also included studies with a separate analysis of the pts with AF subpopulation. Results: Mortality rates increased with higher CHADS 2 from 2.28% (2.00%–2.58%) to 13.2% (8.24%–20.8%) per year and CHA 2 DS 2 -VASc scores risk ratio 1.26 (1.21–1.32), P < 0.0001 for score ≥3. CHADS 2 and CHA 2 DS 2 -VASc predicted poor outcome in stroke odds ratio (OR) ranging 1.42–6 for CHADS 2 and 1.3–7.3 for CHA 2 DS 2 -VASc. Acute myocardial infarction rates increased with higher CHADS 2 OR 2.120 (1.942–2.315) P < 0.001 and CHA 2 DS 2 -VASc OR 1.63 (1.53–1.75), P < 0.001. Limited data were reported for ABC( Age, Biomarkers, Clinical histoty) and R 2 CHADS 2 . No statistically significant correlation was found for major bleeding. Conclusions: CHADS 2 and CHA 2 DS 2 -VASc are useful tools in identifying pts with AF at higher risk for all-cause death, regardless of other pathologies. Both scores correlated with the development of acute myocardial infarction, cardiovascular hospitalization, outcome in stroke, major adverse cardiovascular events, and major adverse cardiovascular and cerebral events, but not with serious bleeding.