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CHA(2)DS(2)-VASc score and prognosis in ischemic strokes with atrial fibrillation

Eva Giralt-Steinhauer1, Elisa Cuadrado-Godia, Ángel Ois

  • 1Neurology Department, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autònoma de Barcelona, [corrected] Barcelona, Spain. 96714@parcdesalutmar.cat

Journal of Neurology
|October 11, 2011
PubMed

Insights

The CHA(2)DS(2)-VASc score effectively predicts poor outcomes in atrial fibrillation (AF) stroke patients. Many AF patients with stroke are undertreated with anticoagulation, despite high risk scores.

Area of Science:

  • Neurology
  • Cardiology
  • Public Health

Background:

  • Atrial fibrillation (AF) is a common cause of ischemic stroke.
  • The CHA(2)DS(2)-VASc score is a validated tool for assessing stroke risk in AF patients.
  • Effective anticoagulation is crucial for preventing stroke in AF patients.

Purpose of the Study:

  • To evaluate the distribution and prognostic significance of the CHA(2)DS(2)-VASc score in ischemic stroke patients with AF.
  • To assess the association between the CHA(2)DS(2)-VASc score and 3-month outcomes in this cohort.
  • To identify potential gaps in anticoagulation therapy among AF patients experiencing stroke.

Main Methods:

  • A cohort of 439 consecutive ischemic stroke patients with AF was analyzed.
  • The CHA(2)DS(2)-VASc score was calculated based on pre-stroke clinical status.
  • Logistic regression was used to analyze the association between the CHA(2)DS(2)-VASc score and poor outcome (modified Rankin Scale 3-6 at 3 months).

Main Results:

  • Over 95% of patients had a CHA(2)DS(2)-VASc score greater than 1, indicating increased stroke risk.
  • Only 41.8% of patients with diagnosed AF were on oral anticoagulation at the time of stroke.
  • The CHA(2)DS(2)-VASc score was independently associated with poor 3-month outcomes (OR 1.36, P=0.001), even after accounting for stroke severity.
  • Therapeutic anticoagulation was associated with improved stroke prognosis (OR 0.45, P=0.016) when stroke severity was excluded from analysis.

Conclusions:

  • The CHA(2)DS(2)-VASc score is a strong independent predictor of poor outcomes in ischemic stroke patients with AF.
  • A significant proportion of AF patients experiencing stroke are undertreated with oral anticoagulation, highlighting a critical gap in care.
  • Improved adherence to anticoagulation guidelines is essential to reduce stroke recurrence and improve outcomes in AF patients.

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