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Ischemic stroke risk estimation in patients without oral anticoagulation: an observational cohort study based on

Felix S Wicke1, Martin A Schaller2, Kateryna Karymova3

  • 1Institute of General Practice, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany. wicke@allgemeinmedizin.uni-frankfurt.de.

BMC Cardiovascular Disorders
|April 25, 2019
PubMed

Insights

Stroke risk in atrial fibrillation (AF) patients is assessed using the CHA₂DS₂-VASc score. This study found lower ischemic stroke rates in a German AF population compared to international data, suggesting potential regional differences in risk stratification.

Area of Science:

  • Cardiology
  • Neurology
  • Epidemiology

Background:

  • Oral anticoagulants are crucial for preventing ischemic stroke in atrial fibrillation (AF) patients.
  • Accurate stroke risk assessment is essential before initiating oral anticoagulants.
  • The CHA₂DS₂-VASc score is the current guideline-recommended tool for stroke risk assessment in AF.

Purpose of the Study:

  • To estimate ischemic stroke risk stratified by the CHA₂DS₂-VASc score in a representative German AF population.
  • To compare these estimated risks with findings from previous international studies.
  • To evaluate the applicability of the CHA₂DS₂-VASc score in a specific geographic region.

Main Methods:

  • Retrospective cohort study utilizing secondary data from patients with atrial fibrillation.
  • CHA₂DS₂-VASc scores were calculated based on 2014 diagnoses.
  • Outcomes (ischemic stroke, thromboembolic events) were assessed during 2015-2016.

Main Results:

  • The incidence rate of ischemic stroke was 2.2 per 100 person-years (961/30,299 patients).
  • The incidence rate of any thromboembolic event was 3.6 per 100 person-years (1553/30,299 patients).
  • Ischemic stroke rates stratified by CHA₂DS₂-VASc score were generally lower than previously reported international data.

Conclusions:

  • The CHA₂DS₂-VASc score's performance in the German population differs from international findings, showing a trend towards lower ischemic stroke risk.
  • These results highlight potential regional variations in stroke risk among AF patients.
  • Further refinement of stroke risk estimation tools for atrial fibrillation patients is warranted.
Abstract

Keywords:
AnticoagulationAtrial fibrillationCHA2DS2-VASc-scoreCardiovascular epidemiologyIncidence rateIschemiaRisk assessmentStroke

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