Age 55-59 years with no risk factors in Asian AF patients conferred a similar ischemic stroke risk to having 1 risk score (1.94 vs 2.06 per 100 person-years; HR 0.95, 95% CI 0.90-1.00).
Cohort (n=426,650)
Yes
Does lowering the age threshold to 55 years better predict ischemic stroke risk in Asian patients with atrial fibrillation?
Lowering the age threshold for stroke risk in the CHA2DS2-VASc score from 65 to 55 years may be appropriate for Asian patients with atrial fibrillation.
Effect estimate: HR 0.95 (95% CI 0.90-1.00)
Absolute Event Rate: 1.94% vs 2.06%
Background and Purpose— Although older age is one of the most important risk factor for stroke in atrial fibrillation (AF), the appropriate age threshold (eg, CHA 2 DS 2 -VASc score congestive heart failure, hypertension, age ≥75 years (doubled), diabetes mellitus, prior stroke or transient ischemic attack (doubled), vascular disease, age 65–74 years, female, 1 point for age 65–74 years, 2 points for age ≥75 years) for increased risk is controversial because actual age thresholds may differ between countries and ethnic groups. We investigated the age threshold for ischemic stroke risk among Asian AF patients. Methods— Using National Health Insurance Service database, including 426 650 oral anticoagulant–naive nonvalvular AF patients from 2005 to 2015, with ≤2 nongender-related CHA 2 DS 2 -VASc risk scores (CHA 2 DS 2 -VASc score 0–2 in males, 1–3 in females), we assessed the risk of ischemic stroke in AF patients according to the age. Results— Patients who fulfill the age risk criterion (age, 65–74 years) without other risk factors showed a significantly higher risk of stroke (4.76 per 100 person-years 100PY; adjusted hazard ratio, 2.25; 95% confidence interval CI, 2.17–2.36) compared with patients with 1 risk score other than age (1.87/100PY). Patients aged 55 to 59 years with no risk factors showed similar risk of stroke (1.94/100PY; adjusted hazard ratio, 0.95; 95% confidence interval, 0.90–1.00) than patients with 1 risk score (2.06/100PY). Patients aged 65 to 69 years and no other risk factors had similar stroke risk (4.08/100PY; adjusted hazard ratio, 0.93; 95% confidence interval, 0.90–0.97) than patients with 2 nongender-related risk scores (4.42/100PY). Conclusions— Older age is the most important predictor of ischemic stroke in AF, particularly for patients with low to intermediate risk of stroke. These nationwide data suggest lowering the current age threshold (age, ≥65 years) in the CHA 2 DS 2 -VASc score to age ≥55 years might be appropriate among Asian patients with AF.
Kim et al. (Mon,) conducted a cohort in Nonvalvular atrial fibrillation (n=426,650). Age 55-59 years with no risk factors vs. 1 risk score was evaluated on Ischemic stroke (HR 0.95, 95% CI 0.90-1.00). Age 55-59 years with no risk factors in Asian AF patients conferred a similar ischemic stroke risk to having 1 risk score (1.94 vs 2.06 per 100 person-years; HR 0.95, 95% CI 0.90-1.00).