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Comparison between CHADS2 and CHA2 DS2 -VASc score in a stroke cohort with atrial fibrillation
E Giralt-Steinhauer1, E Cuadrado-Godia, A Ois
1Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain. 96714@parcdesalutmar.cat
Insights
The CHA2DS2-VASc score offers improved stroke risk prediction in atrial fibrillation (AF) patients compared to CHADS2. This study found that CHA2DS2-VASc identifies more AF patients requiring anticoagulation for stroke prevention.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Stroke risk stratification in atrial fibrillation (AF) is crucial for optimizing antithrombotic therapy.
- The CHADS2 score is widely used but has limitations in predicting embolic events.
- The CHA2DS2-VASc score offers enhanced risk prediction accuracy.
Purpose of the Study:
- To evaluate the distribution of CHADS2 and CHA2DS2-VASc scores in patients with AF and first-ever ischemic stroke (FIS).
- To compare the embolic risk stratification capabilities of CHADS2 versus CHA2DS2-VASc.
- To assess the concordance between stroke risk scores and prescribed antithrombotic treatment.
Main Methods:
- A cohort of 589 patients with FIS, modified Rankin score ≤ 3, and non-valvular AF was analyzed.
- Demographic data, vascular risk factors, and pre-stroke antithrombotic use were recorded.
- CHADS2 and CHA2DS2-VASc scores were calculated based on clinical status prior to stroke.
Main Results:
- 31.6% of patients had previously undiagnosed AF.
- Only 32.2% of patients with a CHADS2 score ≥ 2 were on anticoagulants, with many having inadequate INR.
- CHA2DS2-VASc reclassified 85.2% of patients from low-intermediate CHADS2 risk to high risk, indicating a need for anticoagulation.
Conclusions:
- A significant proportion of FIS patients with AF remain undertreated with antithrombotics, even with high CHADS2 scores.
- The CHA2DS2-VASc score substantially increases the identification of patients indicated for anticoagulation.
- Implementing CHA2DS2-VASc can improve stroke prevention strategies in AF populations.
Background And Purpose:
In patients with atrial fibrillation (AF), stroke risk stratification schemes have been developed to optimize antithrombotic treatment. The CHADS(2) score is frequently used but has limitations. The CHA(2) DS(2) -VASc score improves risk prediction. Our objectives are to describe CHADS(2) and CHA(2) DS(2) -VASc score distribution in a cohort of patients with AF and first-ever ischaemic stroke (FIS) and to identify differences in embolic risk stratification.
Methods:
Our cohort included 589 patients with FIS, previous modified Rankin score ≤ 3, and non-valvular AF. We recorded demographic data, vascular risk factors, and antithrombotic pre-treatment. The CHADS(2) and CHA(2) DS(2) -VASc scores were calculated according to clinical status before stroke onset.
Results:
In 186 (31.6%) patients, AF was previously unknown. Of patients with known AF and CHADS(2) ≥ 2 (n=320), only 103 (32.2%) were taking anticoagulants; more than half of these patients had an INR <2. The CHADS(2) score placed 142 (24.1%) patients in the low-intermediate risk (score ≤ 1) category compared with 21 (3.6%) with CHA(2) DS(2) -VASc, P < 0.001. Applying CHA(2) DS(2) -VASc reclassified 121 (85.2%) subjects in the CHADS(2) low-intermediate risk category as high risk (≥ 2), an indication for anticoagulants. Of the 21 patients who suffered a stroke despite their low CHA(2) DS(2) -VASc score (≤ 1), seven (33.3%) reported alcohol overuse, and six (28.5%) had a concomitant stroke etiology.
Conclusions:
About 25% of FIS patients with AF had a CHADS(2) score ≤ 1. Despite the high CHADS(2) score of our population, few patients received the recommended antithrombotic treatment according to their thromboembolic risk. Using the CHA(2) DS(2) -VASc schema significantly increased the percentage of patients indicated for anticoagulation.
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