Can Patients at Elevated Risk of Stroke Treated With Anticoagulants Be Further Risk Stratified?
Key result
The CHADS2 (c=0.65), Framingham (c=0.64), and SPAF (c=0.61) risk classification schemes predicted ischemic stroke significantly better than chance in AF patients receiving anticoagulants.
Why the study?
Do stroke risk classification schemes accurately predict ischemic stroke in patients with atrial fibrillation receiving optimal anticoagulant therapy?
Population
7329 patients with chronic or paroxysmal nonvalvular atrial fibrillation who were at moderate or high risk…
Design
Cohort
Follow-up
11,245 patient-years of follow-up
Authors
Discussion
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Member takes
Implication
Schemes retain modest discrimination on anticoagulation; extends validation to treated AF but leaves open impact on outcomes.
Study Design
Type
Cohort (n=7,329)
Structured PICO
Do stroke risk classification schemes accurately predict ischemic stroke in patients with atrial fibrillation receiving optimal anticoagulant therapy?
P
Population
7329 patients with chronic or paroxysmal nonvalvular atrial fibrillation who were at moderate or high risk of ischemic stroke, receiving anticoagulant therapy
I
Intervention
Stroke risk classification schemes (American College of Chest Physicians 2001, American College of Chest Physicians 2004, Stroke Prevention in Atrial Fibrillation [SPAF], Atrial Fibrillation Investigators, Framingham, van Walraven, and CHADS2)
O
Outcome
Ischemic stroke, as determined by a central event adjudication committeehard clinical
Main Result
Effect estimate: c-statistic 0.65 (CHADS2), 0.64 (Framingham), 0.61 (SPAF)
The CHADS2, SPAF, and Framingham risk schemes can predict ischemic stroke better than chance in anticoagulated patients with atrial fibrillation, potentially identifying those needing more aggressive intervention.
Cite This Study
Baruch et al. (2007) conducted a cohort in chronic or paroxysmal nonvalvular atrial fibrillation (n=7,329). Stroke risk classification schemes (CHADS2, Framingham, SPAF) vs. Chance was evaluated on ischemic stroke (c-statistic 0.65 (CHADS2), 0.64 (Framingham), 0.61 (SPAF)). The CHADS2 (c=0.65), Framingham (c=0.64), and SPAF (c=0.61) risk classification schemes predicted ischemic stroke significantly better than chance in AF patients receiving anticoagulants.