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Limitations of CHADS2 scoring system in predicting stroke risk--need to change the age criteria
Blerim Berisha1, Masar Gashi, Xhevdet Krasniqi
1Cardiology Department, Internal Clinic, University Clinical Center of Kosova, Prishtina, Republic of Kosova. drblerimberisha@yahoo.com
Insights
Stroke risk is higher in patients aged 65-74 with atrial fibrillation (AF) and low CHADS2 scores, especially without anticoagulation. Age modification of the CHADS2 system may be needed.
Area of Science:
- Cardiology
- Neurology
- Geriatrics
Background:
- Atrial fibrillation (AF) is a common arrhythmia strongly linked to aging.
- Stroke is a significant complication of AF, necessitating risk stratification.
Purpose of the Study:
- To evaluate stroke rates in relation to age and anticoagulation status.
- To assess the effectiveness of the CHADS2 risk criteria in predicting stroke in AF patients.
Main Methods:
- Retrospective analysis of 302 non-valvular AF patients (2007-2009) with at least one-year follow-up.
- CHADS2 score calculation and assessment of anticoagulation status at stroke onset.
- Stratification of stroke rates by age groups and CHADS2 scores.
Main Results:
- 13.9% of patients experienced stroke; higher rates observed in the 65-74 age group (22.5%, P=0.014).
- Patients aged 65-74 with stroke had a mean age of 67.2 years.
- A significant proportion of stroke patients (23) in the 65-74 age group had CHADS2 scores of 0-1.
Conclusions:
- The 65-74 age group with low CHADS2 scores (0-1) and no anticoagulation faced a higher stroke risk.
- Current CHADS2 scoring may underestimate stroke risk in certain age demographics.
- Consideration for modifying the CHADS2 system to better incorporate age as a risk factor is recommended.
Introduction:
Atrial fibrillation (AF) is the most common arrhythmia with a strong association with age. The aim of this study was to evaluate the rate of stroke in relation to age and anticoagulation status based on CHADS2 risk criteria.
Methods:
This study included all patients with non-valvular atrial fibrillation admitted to our clinic between 1/11/2007 and 1/11/2009, with minimum one year follow up for patients without stroke. We calculated risk based on CHADS2 (C-cardiac failure, H- hypertension, A-age >75 years, D-diabetes mellitus, S-stroke) point system and evaluated anticoagulation status at the moment of first occurrence of stroke. We observed the rate of stroke in different group age.
Results:
The average of participants with AF was 67.9 +/- 10.3 years. Amongst 302 patients with non-valvular atrial fibrillation, 32.5% had been anticoagulated while 13.9% of experienced stroke. The stroke were more present in patients who used aspirin in age group 65-74 (22.5%, P = 0.014). The mean age of patients who experienced stroke were 67.2, SD +/- 10.8 vs. 71.6, SD +/- 5.1, P = 0.000. Of the patients with stroke from age group 65-74 years, 23 were in CHADS2 0-1 scoring system.
Conclusion:
The higher rate of stroke was in the 65-74 years age group, with CHADS2 scoring system 0-1, and without anticoagulation therapy. Therefore modification has to be considered for the CHADS2 scoring system to account the age as a risk factor for population in different regions.
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