What does this research mean for the field?

A high-risk CHADS2 score at hospital admission independently predicts poor neurological outcome and increased long-term all-cause and vascular mortality following atrial fibrillation-related ischemic stroke. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 1, 2012Journal of Clinical NeurologyOpen Access

Impact of CHADS2Score on Neurological Severity and Long-Term Outcome in Atrial Fibrillation-Related Ischemic Stroke

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation-related acute ischemic stroke (n=298). Intervention: High-risk CHADS2 score (3-6 points) vs. Low-risk CHADS2 score (0 points). Primary outcome: Poor neurological outcome (NIHSS score ≥2 at discharge) (OR 4.17, 95% CI 1.76-9.87, p=0.001).

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Key result

High admission CHADS2 score is linked to ~4-fold higher odds of poor stroke outcome.

OR 4.17
95% CI 1.76-9.87
P=0.001
n=298

Why the study?

The relationship between CHADS2 score and stroke severity and outcome in patients with atrial fibrillation-related ischemic stroke had not been elucidated.

Does a high CHADS2 score predict poor neurological outcome and mortality in patients with atrial fibrillation-related ischemic stroke?

Study Design

Type

Cohort (n=298)

Multicenter

Structured PICO

Does a high CHADS2 score predict poor neurological outcome and mortality in patients with atrial fibrillation-related ischemic stroke?

Population

298 patients with atrial fibrillation-related acute ischemic stroke admitted within 7 days of symptom onset, followed for a mean of 29 months.

Exposure

High-risk CHADS2 score (3-6 points) at admission

Comparator

Low-risk (0 points) or intermediate-risk (1-2 points) CHADS2 score

Outcome

Poor neurological state (defined as NIHSS score ≥2 and mRS score ≥3 at discharge) and mortality (all-cause and vascular death)hard clinical

Main Result

Odds Ratio: 4.17 (95% CI 1.76–9.87)

p-value: p=0.001

The CHADS2 score, traditionally used to estimate future stroke risk in atrial fibrillation, also predicts neurological severity and long-term mortality after an ischemic stroke occurs.

Limitations

Single-center study with mostly Korean subjects, limiting generalizability
Neurological severity was estimated at discharge instead of the more common 3 months post-onset
Potential inclusion of strokes caused by other mechanisms such as small-vessel occlusion
Lack of information on medication compliance and International Normalized Ratio (INR) levels during follow-up

Implication

High CHADS2 scores were associated with worse AF-stroke outcomes; extends CHADS2 utility but remains hypothesis-generating.

Abstract

BACKGROUND AND PURPOSE: The CHADS(2) (an acronym for congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and prior stroke or transient ischemic attack or thromboembolism) score is a widely used system for estimating the risk of stroke in patients with atrial fibrillation. However, how the CHADS(2) score is related to stroke severity and outcome in patients with strokes due to atrial fibrillation has not yet been elucidated. METHODS: We enrolled patients with atrial fibrillation who visited our stroke center within 7 days after the onset of acute ischemic stroke between October 2002 and September 2008. CHADS(2) scores were categorized into three groups: 0 points, low risk; 1 or 2 points, intermediate risk; and 3-6 points, high risk. Poor neurological state was defined as follows: a National Institutes of Health Stroke Scale (NIHSS) score of ≥2, and a modified Rankin Scale (mRS) score of ≥3 at discharge. Mortality information was ascertained as at December 2008. RESULTS: A cohort of 298 patients with atrial-fibrillation-related stroke was included in this study. A high-risk CHADS(2) score at admission was a powerful predictor of poor neurological outcome [for NIHSS: odds ratio (OR), 4.17; 95% confidence interval (CI), 1.76-9.87; for mRS: OR, 2.97; 95% CI, 1.23-7.16] after controlling for all possible confounders. In addition, a high-risk CHADS(2) score was an independent predictor of all causes of death during the follow-up [hazard ratio (HR), 3.01; 95% CI, 1.18-7.65] and vascular death (HR, 12.25; 95% CI, 1.50-99.90). CONCLUSIONS: Although the CHADS(2) score was originally designed to distinguish patients with a future risk of stroke, our study shows that it may also be used to predict poor neurological outcome after atrial-fibrillation-related stroke.

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Cite This Study

Kim et al. (2012) conducted a cohort in Atrial fibrillation-related acute ischemic stroke (n=298). High-risk CHADS2 score (3-6 points) vs. Low-risk CHADS2 score (0 points) was evaluated on Poor neurological outcome (NIHSS score ≥2 at discharge) (OR 4.17, 95% CI 1.76-9.87, p=0.001). A high-risk CHADS2 score at admission independently predicted poor neurological outcome (OR 4.17) and long-term all-cause mortality (HR 3.01) after atrial fibrillation-related ischemic stroke.

synapsesocial.com/papers/6ab9d3d78675c5e558208289 https://doi.org/10.3988/jcn.2012.8.4.251