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Survival after stroke--the impact of CHADS2 score and atrial fibrillation
Karin M Henriksson1, Bahman Farahmand, Saga Johansson
1Department of Laboratory Medicine, Lund University, Lund, Sweden. Karin.Henriksson@med.lu.se
Insights
Atrial fibrillation (AF) significantly increases stroke mortality risk. The CHADS(2) score effectively predicts survival post-stroke, with higher scores indicating poorer outcomes for both AF and non-AF patients.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Atrial fibrillation (AF) is a common arrhythmia associated with increased risk of stroke and mortality.
- Understanding the impact of AF and risk stratification scores on post-stroke mortality is crucial for patient management.
Purpose of the Study:
- To investigate all-cause mortality in stroke patients with and without documented AF.
- To evaluate the predictive value of the CHADS(2) score on mortality in stroke patients.
Main Methods:
- A large cohort of 105,074 Swedish patients from 2001-2005 was analyzed.
- Patients were categorized into those with and without documented AF.
- Mortality data and pre-stroke CHADS(2) scores were obtained from national registers.
Main Results:
- Patients with AF had a 1.46-fold increased risk of death compared to those without AF.
- Advanced age (>75 years) was the strongest predictor of mortality, followed by heart failure, prior stroke, and diabetes.
- The CHADS(2) score demonstrated significant predictive power for mortality in both AF and non-AF stroke patients.
Conclusions:
- The CHADS(2) score is a valuable tool for assessing all-cause mortality risk in stroke patients, irrespective of AF status.
- Risk stratification using the CHADS(2) score can inform prognosis and management strategies for diverse patient populations.
- The findings highlight the substantial impact of AF on post-stroke survival.
Objective:
This study examined all-cause mortality in stroke patients with and without documented atrial fibrillation (AF), and the impact of CHADS(2) score.
Design:
A cohort of 105,074 patients, 31,821 (30.3%) with and 73,253 (69.7%) without documented AF, was studied. These patients were registered in the Swedish Stroke Registry during the years 2001-2005. Mortality data were retrieved from the Swedish Cause of Death Register. CHADS(2) score prior to stroke were assessed using the Swedish National Discharge Register.
Results:
The age and sex adjusted relative risk (RR) of death was 1.46 (1.43-1.49) for AF vs non-AF patients. High age (>or=75 years) tripled the risk of death and was the single most important predictor, followed by congestive heart failure, previous stroke and diabetes. Less than half of the AF patients with a CHADS(2) score of 1-6 survived more than 5 years, whereas AF patients with a CHADS(2) score of 0 had a 73% chance of survival. In patients with AF, the relative risk of death was 6.05 (CI: 2.26-6.95); in subjects with the highest vs the lowest CHADS(2) score; the corresponding RR for non-AF patients was 7.93 (CI: 7.01-8.97).
Conclusions:
The CHADS(2) score seems to have an impact on all-cause mortality after stroke. The CHADS(2) score can give valuable insight for other outcome variables apart from having had an ischemic stroke and can be applied to patients with different risk factor profiles, e.g. with a previous known cardiovascular disease but without known AF.
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