Key result
Higher HAVOC scores successfully stratified the risk of atrial fibrillation detection at 12 months, with rates of 11%, 18%, and 32% across low, intermediate, and high score groups.
Why the study?
The HAVOC score was previously developed to predict AF risk after cryptogenic stroke or TIA, but its performance needed evaluation in patients with insertable cardiac monitors from the CRYSTAL AF study.
Does the HAVOC score predict the risk of atrial fibrillation detection by insertable cardiac monitors in patients with cryptogenic stroke or TIA?
Cohort (n=214)
Does the HAVOC score predict the risk of atrial fibrillation detection by insertable cardiac monitors in patients with cryptogenic stroke or TIA?
The HAVOC score successfully stratifies the risk of atrial fibrillation detection in patients with cryptogenic stroke or TIA monitored with an insertable cardiac monitor.
Answers are grounded in this paper and cite their sources.
May support HAVOC-based AF stratification post-stroke; leaves open prospective validation before practice change.
Background: The HAVOC score was previously developed to predict the risk of atrial fibrillation (AF) after cryptogenic stroke (CS) or transient ischemic attack (TIA). The purpose of this study was to apply the HAVOC score to patients who received insertable cardiac monitors (ICMs) in the CRYSTAL AF study. Methods: All patients from the CRYSTAL AF study who received an ICM were included. HAVOC score (one point each for peripheral vascular disease and obesity with body mass index >30, two points each for hypertension, age ⩾ 75, valvular heart disease, and coronary artery disease, 4 points for congestive heart failure) was computed for all patients. The primary endpoint was AF detection by 12 months of ICM monitoring. Results: A total of 214 patients who received ICM were included. AF was detected in 40 patients while the remaining 174 patients were AF negative. The HAVOC score was significantly higher among patients with AF [median 3.0 with interquartile range (IQR) 2–4] than those without AF [median 2.0 (IQR 0–3)], p = 0.01. AF increased significantly across the three HAVOC score groups: 11% in Group A (score 0–1), 18% in Group B (score 2–3), and 32 % in Group C (score ⩾ 4) with p = 0.02. Conclusions: The HAVOC score was shown in this post hoc analysis of CRYSTAL AF to successfully stratify AF risk post CS or TIA. The 11% AF rate in the lowest HAVOC score group highlights the significance of nontraditional contributors to AF and ischemic stroke.
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Zhao et al. (2019) conducted a cohort in Cryptogenic stroke or transient ischemic attack (n=214). HAVOC score vs. Lower HAVOC score groups was evaluated on Atrial fibrillation detection by 12 months of ICM monitoring (p=0.02). Higher HAVOC scores successfully stratified the risk of atrial fibrillation detection at 12 months, with rates of 11%, 18%, and 32% across low, intermediate, and high score groups.
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