What question did this study set out to answer?

To evaluate agreement among four clinical classification schemes in predicting stroke risk and determine their impact on thromboprophylaxis eligibility in nonvalvular atrial fibrillation.

September 1, 2005Academic Emergency MedicineOpen Access

Differences among Clinical Classification Schemes for Predicting Stroke in Atrial Fibrillation: Implications for Therapy in Daily Practice

Q: What is the clinical evidence from this study?

Study design: Observational. Population: nonvalvular atrial fibrillation (NVAF) (n=1220). Intervention: Clinical classification schemes (AFI, SPAF, CHADS2, ACCP). Primary outcome: Agreement in predicting the risk of stroke among four clinical classification schemes.

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Key result

Four clinical classification schemes for stroke risk in atrial fibrillation showed poor to medium agreement (kappa 0.01-0.52), causing relevant differences in identifying patients for anticoagulation.

Why the study?

Do different clinical classification schemes for predicting stroke in NVAF agree in their risk stratification and treatment recommendations?

Key Points

To evaluate agreement among four clinical classification schemes in predicting stroke risk and determine their impact on thromboprophylaxis eligibility in nonvalvular atrial fibrillation.
Prospective, multicenter observational study of adults with nonvalvular atrial fibrillation across 12 emergency departments in July 2000 and February 2001 (N=1,220).
Compared stroke risk stratification (high, moderate, low) and therapy eligibility across AFI, SPAF, CHADS2, and ACCP classification systems using Cohen's kappa.
High-risk stroke categorization differed substantially across schemes: 86% for ACCP, 70% for AFI, 38% for SPAF, and 13% for CHADS2.
Agreement for stroke risk stratification was poor across most schemes (kappa = 0.01 to 0.18), with only moderate agreement between AFI and ACCP (kappa = 0.52).
Agreement for selecting anticoagulation or antiplatelet therapy varied widely from poor to high, ranging from kappa = 0.03 (CHADS2 vs. ACCP) to kappa = 0.91 (AFI vs. ACCP).

Study Design

Type

Observational (n=1,220)

Multicenter

Yes

Structured PICO

Do different clinical classification schemes for predicting stroke in NVAF agree in their risk stratification and treatment recommendations?

Population

1,220 adults with nonvalvular atrial fibrillation evaluated in 12 emergency departments to compare four clinical classification schemes for stroke risk.

Exposure

Clinical classification schemes for predicting stroke (AFI, SPAF, CHADS2, ACCP)

Comparator

Comparison among the four schemes

Outcome

Agreement in predicting the risk of stroke and selecting patients eligible for antiplatelet therapy or anticoagulationsurrogate

There is significant discordance among different clinical classification schemes for stroke risk in NVAF, leading to widely varying recommendations for anticoagulation in clinical practice.

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

May produce inconsistent anticoagulation decisions in NVAF; leaves open optimal scheme validation against outcomes.

Cite This Study

Laguna et al. (2005) conducted an observational in nonvalvular atrial fibrillation (NVAF) (n=1,220). Clinical classification schemes (AFI, SPAF, CHADS2, ACCP) was evaluated on Agreement in predicting the risk of stroke among four clinical classification schemes. Four clinical classification schemes for stroke risk in atrial fibrillation showed poor to medium agreement (kappa 0.01-0.52), causing relevant differences in identifying patients for anticoagulation.

synapsesocial.com/papers/6a919a50fe6bc987f0fb5b0e https://doi.org/10.1197/j.aem.2005.04.018

Topics

Atrial fibrillation Persistent AF management Anticoagulation in AF

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Differences among Clinical Classification Schemes for Predicting Stroke in Atrial Fibrillation: Implications for Therapy in Daily Practice

Key Points

Study Design

Structured PICO

Discussion

Implication

Cite This Study

Topics

Differences among Clinical Classification Schemes for Predicting Stroke in Atrial Fibrillation: Implications for Therapy in Daily Practice

Key Points

Study Design

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider