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A Clinical Score for Predicting Atrial Fibrillation in Patients with Cryptogenic Stroke or Transient Ischemic Attack
Calvin Kwong1, Albee Y Ling, Michael H Crawford
1Department of Medicine, Santa Clara Valley Medical Center, San Jose, CA, USA.
Insights
Detecting atrial fibrillation (AF) in patients after cryptogenic stroke (CS) or transient ischemic attack (TIA) is crucial. The new HAVOC score helps identify high-risk individuals for extended monitoring.
Area of Science:
- Neurology
- Cardiology
- Clinical Research
Background:
- Atrial fibrillation (AF) detection in cryptogenic stroke (CS) or transient ischemic attack (TIA) patients has significant therapeutic implications.
- Risk stratification is essential for identifying patients likely to develop AF post-CS/TIA.
Purpose of the Study:
- To develop and validate a risk-scoring system for predicting the later development of AF in patients who have experienced CS or TIA.
- To aid in selecting patients for extended rhythm monitoring based on their AF risk.
Main Methods:
- A retrospective cohort study was conducted using data from 1995 to 2015 from the Stanford Translational Research Integrated Database Environment (STRIDE).
- Included were 9,589 adult patients (age ≥40 years) with CS/TIA.
- A risk-scoring system, the HAVOC score, was developed using 7 identified clinical risk factors.
Main Results:
- 5% (482) of patients developed AF post-CS/TIA, with diagnoses occurring 1-12 months, 1-3 years, and >3 years after the event.
- Significant risk factors included advanced age (≥75 years), obesity, congestive heart failure, hypertension, coronary artery disease, peripheral vascular disease, and valve disease.
- The HAVOC score demonstrated good model discrimination (area under the curve = 0.77) and stratified patients into 3 risk groups.
Conclusions:
- The findings support prolonged and thorough AF screening in post-CS/TIA patients.
- The HAVOC score effectively stratifies AF risk and can guide the selection of patients for extended rhythm monitoring.
Objectives:
Detection of atrial fibrillation (AF) in post-cryptogenic stroke (CS) or transient ischemic attack (TIA) patients carries important therapeutic implications.
Methods:
To risk stratify CS/TIA patients for later development of AF, we conducted a retrospective cohort study using data from 1995 to 2015 in the Stanford Translational Research Integrated Database Environment (STRIDE).
Results:
Of the 9,589 adult patients (age ≥40 years) with CS/TIA included, 482 (5%) patients developed AF post CS/TIA. Of those patients, 28.4, 26.3, and 45.3% were diagnosed with AF 1-12 months, 1-3 years, and >3 years after the index CS/TIA, respectively. Age (≥75 years), obesity, congestive heart failure, hypertension, coronary artery disease, peripheral vascular disease, and valve disease are significant risk factors, with the following respective odds ratios (95% CI): 1.73 (1.39-2.16), 1.53 (1.05-2.18), 3.34 (2.61-4.28), 2.01 (1.53-2.68), 1.72 (1.35-2.19), 1.37 (1.02-1.84), and 2.05 (1.55-2.69). A risk-scoring system, i.e., the HAVOC score, was constructed using these 7 clinical variables that successfully stratify patients into 3 risk groups, with good model discrimination (area under the curve = 0.77).
Conclusions:
Findings from this study support the strategy of looking longer and harder for AF in post-CS/TIA patients. The HAVOC score identifies different levels of AF risk and may be used to select patients for extended rhythm monitoring.
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