CHA2DS2-VASc Score and Heart Rate Predict Ischemic Stroke Outcomes in Patients withAtrial Fibrillation
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Published on: July 20, 2022
Chih-Shan Huang1, Chin-I Chen1, Ya-Ting Liu1
1Department of Neurology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan;
Insights
In patients with atrial fibrillation (AF) and ischemic stroke, elevated CHA2DS2-VASc scores and higher heart rates predict worse outcomes. Female gender, no prior warfarin use, and heart rate independently predict stroke severity.
Area of Science:
- Cardiology
- Neurology
- Clinical Research
Background:
- Atrial fibrillation (AF) is a common arrhythmia associated with an increased risk of ischemic stroke.
- Predicting stroke severity and outcomes in AF patients is crucial for effective management.
- Existing risk scores may not fully capture all relevant factors influencing stroke outcomes in this population.
Purpose of the Study:
- To identify key factors determining the severity and outcomes of ischemic stroke in patients diagnosed with atrial fibrillation (AF).
- To evaluate the predictive value of demographic, clinical, and risk stratification scores for stroke outcomes in AF patients.
Main Methods:
- A cohort of 210 patients with AF and acute ischemic stroke was analyzed.
- Factors investigated included age, gender, comorbidities, CHADS2 and CHA2DS2-VASc scores, warfarin use, heart rate, and blood pressure.
- Stroke severity (NIHSS scores), hospitalization duration, and mortality rate were assessed as outcome measures.
Main Results:
- Patients with poor outcomes (NIHSS ≥ 8) had significantly higher CHA2DS2-VASc scores, were older, predominantly female, had less prior warfarin use, and higher heart rates.
- These patients also experienced longer hospitalizations and higher mortality rates compared to those with better outcomes.
- Multivariate analysis identified female gender, absence of prior warfarin use, and elevated heart rate as independent predictors of stroke severity.
Conclusions:
- CHADS2 and CHA2DS2-VASc scores are valuable for predicting outcomes in ischemic stroke patients with AF.
- Heart rate emerges as a significant and independent predictor of stroke severity and outcome in this patient group.
- These findings underscore the importance of comprehensive risk assessment and monitoring of heart rate in AF patients at risk for stroke.
Purpose:
To evaluate the factors determining the severity and outcome of ischemic stroke in patients with atrial fibrillation (AF).
Methods:
Our study examined 210 patients with AF and acute ischemic stroke to investigate the relative risks of age, gender, comorbidities, CHADS2 and CHA2DS2-VASc scores, warfarin use, heart rate, and blood pressure on stroke severity, hospitalization duration, and mortality rate.
Results:
Patients with poor outcomes [n = 109, National Institutes of Health Stroke Scale (NIHSS) scores of ≥ 8] had elevated CHA2DS2-VASc scores [5, interquartile range (IQR) 3-6 versus 4, IQR 2.5-5, p = 0.005] and were older with a female predominance, less prior warfarin use, and a higher heart rate (93 ± 24 versus 84 ± 20 beats/min, p = 0.004) in the emergency department, with a longer duration of hospitalization (24 ± 23 versus 11 ± 12 days, p < 0.001) and a higher mortality rate (11.0% versus 0.0%, p = 0.002) than those with better outcomes (n = 101, low NIHSS scores of ≤ 7). Patients who died (n = 12) were older and had a higher NIHSS, CHADS2 (3.5, IQR 2-4.75 versus 2, IQR 1-4, p = 0.040), or CHA2DS2-VASc (5.5, IQR 4-6 versus 4, IQR 3-5, p = 0.046) scores than patients who survived. The multivariate analysis showed that female gender, no prior warfarin use, and heart rate were independent predictors of stroke severity.
Conclusions:
Our results showed that CHADS2 and CHA2DS2-VASc scores, and heart rate were useful parameters for predicting outcomes in AF patients with stroke.
Key Words:
Atrial fibrillation; CHA2DS2-VASc score; Heart rate; Ischemic stroke.
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