Key result
RA-CHADSV score ≥1 is linked to a ~7-fold higher risk of ischemic stroke.
Why the study?
To develop a simplified score (RA-CHADSV), modified from the CHA2DS2-VASc score, to predict ischemic stroke risk in patients with rheumatoid arthritis without AF.
Does the RA-CHADSV score predict the risk of ischemic stroke in patients with rheumatoid arthritis without atrial fibrillation?
Cohort (n=592)
Does the RA-CHADSV score predict the risk of ischemic stroke in patients with rheumatoid arthritis without atrial fibrillation?
Relative Risk: 7.39
p-value: p=<0.001
The simplified RA-CHADSV score effectively predicts ischemic stroke risk in non-AF rheumatoid arthritis patients, performing comparably to the CHA2DS2-VASc score.
RA-CHADSV ≥1 was associated with higher stroke risk in RA without AF; hypothesis-generating, requiring prospective validation before clinical adoption.
Background and Objectives: The aim of this retrospective cohort study was to develop a new score (RA-CHADSV) (rheumatoid arthritis - congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack/thromboembolism, and vascular disease), modified from the CHA2DS2-VASc score (congestive heart failure, hypertension, age ≥75 years (doubled), diabetes mellitus, stroke/transient ischemic attack (doubled), vascular disease, age 65–74 years, and female), in predicting the risk of ischemic stroke in rheumatoid arthritis (RA) patients without atrial fibrillation (AF). Materials and Methods: Using the Taiwan’s National Health Insurance Research Database, 592 patients with RA diagnosed between 2000 and 2002 were identified and followed until first occurrence of ischemic stroke or the last available date in the database. Incidence rate ratios (IRR) of ischemic stroke for the CHA2DS2-VASc score were calculated using Poisson regression models. A new prediction score RA-CHADSV was developed using multiple logistic regression analysis with bootstrap validation. Results: The area under the receiver operating characteristic curve of the newly developed RA-CHADSV score and the CHA2DS2-VASc score were 0.73 (95% confidence interval (CI) 0.64–0.82) and 0.70 (95% CI 0.61–0.79), respectively. The RA-CHADSV score was significantly associated with a higher ischemic stroke incidence in the patients who scored ≥1 (adjusted IRR 7.39, p < 0.001). Conclusions: A simplified RA-CHADSV score, with comparable efficiency as the CHA2DS2-VASc score, but easier to use clinically was developed for predicting the risk of ischemic stroke among non-AF RA patients.
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Hsu et al. (2020) conducted a cohort in Rheumatoid arthritis without atrial fibrillation (n=592). RA-CHADSV score ≥1 vs. RA-CHADSV score 0 was evaluated on First occurrence of ischemic stroke (adjusted IRR 7.39, p=<0.001). The newly developed RA-CHADSV score ≥1 was significantly associated with a higher incidence of ischemic stroke compared to a score of 0 (adjusted IRR 7.39, p<0.001).
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