The proposed risk stratification scoring system demonstrated superior discrimination for predicting the 3-year risk of new-onset atrial fibrillation after ischemic stroke compared to CHA2DS2-VASc and CHADS2 scores.
Cohort (n=359,996)
Does a newly developed point-based prediction model improve the prediction of 3-year risk of new-onset atrial fibrillation after ischemic stroke compared to CHADS2 and CHA2DS2-VASc scores?
A novel point-based scoring system outperforms CHADS2 and CHA2DS2-VASc in predicting new-onset atrial fibrillation within 3 years after an ischemic stroke, which may help guide subclinical AF monitoring.
Effect estimate: AUC 0.671 (95% CI 0.667-0.675)
Absolute Event Rate: 0.671% vs 0.636%
p-value: p=<0.001
Atrial fibrillation (AF) is a major independent risk factor of stroke and anticoagulation therapy is needed in patients with AF after ischemic stroke. However, the detection rate of AF is low after ischemic stroke. Developing a prediction model for newly diagnosed AF after ischemic stroke will help to assess the subclinical AF.We identified 98,103 patients with diabetes mellitus (DM) and 261,893 patients without DM, who were not AF history and admitted for newly ischemic stroke from the National Health Insurance Research Database in Taiwan. The prediction model for 3-year incidence of AF after ischemic stroke was derived from multivariate logistic regression and also the accuracy rate of the prediction model was compared with CHA2DS2-VASC and CHADS2 scores as a reference.Four thousand nine hundred seventy six patients in the DM cohort and 16,127 patients in the non-DM cohort developed AF during 3 years of follow-up. The variables in the point-based prediction model for non-DM patients (range: -3-28), included age, heart failure, coronary artery disease, gout, obstructive pulmonary disease, hypertension, female, and statin use, while those for DM patients (range: -2-30) included age, heart failure, coronary artery disease, chronic kidney disease, hypertension, obstructive pulmonary disease, and statin use. Compared to the CHADS2 and CHA2DS2-VASc scoring systems, this scoring system was better at predicting 3-year risk of AF after ischemic stroke in both cohorts.This model might be useful in evaluating the benefit of insertable cardiac monitor implantation and anticoagulation agents in individual patients after ischemic stroke.
Chen et al. (2020) conducted a cohort in Ischemic stroke without prior atrial fibrillation (n=359,996). Proposed risk stratification scoring system vs. CHA2DS2-VASc and CHADS2 scores was evaluated on Prediction of 3-year incidence of atrial fibrillation after ischemic stroke (AUC in non-DM cohort) (AUC 0.671, 95% CI 0.667-0.675, p=<0.001). The proposed risk stratification scoring system demonstrated superior discrimination for predicting the 3-year risk of new-onset atrial fibrillation after ischemic stroke compared to CHA2DS2-VASc and CHADS2 scores.
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