Key result
The Screening for Atrial Fibrillation Scale (SAFE) score ≥ 5 identified paroxysmal atrial fibrillation in ischemic stroke patients with a sensitivity of 83%, a specificity of 80%, and an AUC of 0.88.
Why the study?
Individual selection of ischemic stroke patients at higher risk of AF might increase the diagnostic yield of prolonged cardiac monitoring and render it cost-effective.
Does the SAFE score accurately predict the presence of paroxysmal atrial fibrillation in patients with ischemic stroke without previously documented AF?
Observational (n=460)
No
Does the SAFE score accurately predict the presence of paroxysmal atrial fibrillation in patients with ischemic stroke without previously documented AF?
Effect estimate: AUC 0.88 (95% CI 0.84-0.91)
p-value: p=<0.001
The SAFE score, combining clinical, biomarker, and imaging data, accurately identifies ischemic stroke patients at high risk for occult atrial fibrillation who may benefit from prolonged cardiac monitoring.
SAFE ≥5 may aid paroxysmal AF detection in stroke; leaves open prospective validation before adoption.
Background and Purpose: An individual selection of ischemic stroke patients at higher risk of atrial fibrillation (AF) might increase the diagnostic yield of prolonged cardiac monitoring and render it cost-effective. Methods: The clinical, laboratory, and brain/cardiac imaging characteristics of consecutive ischemic stroke patients without documented AF were recorded. All patients underwent at least 72 h of cardiac monitoring unless AF was diagnosed before, transthoracic echocardiogram, blood biomarkers, and intracranial vessels imaging. A predictive grading was developed by logistic regression analysis, the screening for atrial fibrillation scale (SAFE). Results: A total of 460 stroke patients were analyzed to develop the SAFE scale, a 7-items score (possible total score 0-10): age ≥ 65 years (2 points); history of chronic obstructive pulmonary disease or obstructive sleep apnea (1 point); thyroid disease (1 point); NT-proBNP ≥ 250 pg/ml (2 points); left atrial enlargement (2 points); cortical topography of stroke, including hemispheric or cerebellar cortex (1 point); and intracranial large vessel occlusion (1 point). A score = 5 identified patients with paroxysmal AF with a sensitivity of 83% and a specificity of 80%. Conclusion: Screening for atrial fibrillation scale (SAFE) is a novel and simple strategy for selecting ischemic stroke patients at higher risk of having AF who can benefit from a more thorough etiological evaluation. External validation of SAFE in a multicenter study, with a larger number of patients, is warranted.
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Amaya‐Pascasio et al. (2022) conducted an observational in Ischemic stroke or transient ischemic attack (n=460). Screening for Atrial Fibrillation Scale (SAFE) score ≥ 5 vs. SAFE score < 5 was evaluated on Detection of paroxysmal atrial fibrillation (AUC 0.88, 95% CI 0.84-0.91, p=<0.001). The Screening for Atrial Fibrillation Scale (SAFE) score ≥ 5 identified paroxysmal atrial fibrillation in ischemic stroke patients with a sensitivity of 83%, a specificity of 80%, and an AUC of 0.88.
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