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Augmented intelligence decision tool for stroke prediction combines factors from CHA2 DS2 -VASc and the intermountain
Benjamin D Horne1,2, Victoria Jacobs1, Heidi T May1
1Intermountain Medical Center, Intermountain Heart Institute, Salt Lake, Utah.
Insights
A new risk score, IMRS-VASc, was developed to predict stroke in atrial fibrillation (AF) patients. This dynamic score, using routine lab tests, showed better stroke prediction than traditional CHA₂DS₂-VASc and CHADS₂ scores.
Area of Science:
- Cardiology
- Medical Informatics
- Clinical Risk Prediction
Background:
- Current stroke risk scores like CHA₂DS₂-VASc and CHADS₂ have limited predictive ability.
- These scores use static, dichotomous variables and do not incorporate dynamic clinical data.
- Intermountain Mortality Risk Scores (IMRS) offer a dynamic approach using standard laboratory tests.
Purpose of the Study:
- To derive and validate novel, sex-specific stroke prediction scores for atrial fibrillation (AF) outpatients.
- To integrate variables from CHA₂DS₂-VASc and IMRS into a new dynamic risk score.
- To compare the predictive performance of the new score against existing risk stratification tools.
Main Methods:
- Development of sex-specific "IMRS-VASc" scores using CHA₂DS₂-VASc variables, warfarin use, CBC, and comprehensive metabolic profile in an AF cohort.
- Validation of IMRS-VASc in an independent AF outpatient cohort.
- Comparative analysis of stroke prediction using IMRS-VASc, CHA₂DS₂-VASc, CHADS₂, and IMRS (for mortality).
Main Results:
- IMRS-VASc demonstrated effective stroke stratification in both derivation (females: c=0.703, males: c=0.697) and validation (females: c=0.681, males: c=0.685) cohorts.
- CHA₂DS₂-VASc and CHADS₂ showed substantially weaker stroke prediction capabilities compared to IMRS-VASc.
- IMRS proved to be the strongest mortality predictor (derivation females: c=0.783, males: c=0.796; validation females: c=0.782, males: c=0.794).
Conclusions:
- The derived IMRS-VASc score is a temporally dynamic predictor of stroke in AF outpatients.
- IMRS-VASc exhibited superior stroke prediction compared to traditional CHA₂DS₂-VASc and CHADS₂ scores.
- Further validation and clinical utility assessment of IMRS-VASc for guiding AF patient care are warranted.
Introduction:
CHA2 DS2 -VASc and CHADS2 are computationally simple risk prediction tools used to guide anticoagulation decisions for stroke prophylaxis, but they have modest risk discrimination ability and use static dichotomous variables. The Intermountain Mortality Risk Scores (IMRS) are dynamic decision tools using standard clinical laboratory tests. This study derived new stroke prediction scores using variables from both CHA2 DS2 -VASc and IMRS.
Methods And Results:
In outpatients with first atrial fibrillation (AF) diagnosis at the Intermountain Healthcare (females, n = 26 063 males, n = 29 807), sex-specific "IMRS-VASc" scores were derived using variables from CHA2 DS2 -VASc, warfarin use, the complete blood count, and the comprehensive metabolic profile. Validation was performed in an independent Intermountain outpatient AF cohort (females, n = 11 021; males, n = 12 641). Stroke occurred among 3.1% and 3.1% of females and 2.3% and 2.5% of males in derivation and validation groups, respectively. IMRS-VASc stratified stroke with similar ability in derivation (c-statistics, females: c = 0.703, males: c = 0.697) and validation groups (females: c = 0.681, males: c = 0.685). CHA2 DS2 -VASc (females: c = 0.581 and c = 0.605; males: c = 0.616 and c = 0.613 in derivation and validation, respectively) and CHADS2 (females: c = 0.581 and c = 0.608; males: c = 0.620 and c = 0.621 in derivation and validation, respectively) were substantially weaker stroke predictors. IMRS was the strongest mortality predictor (females: c = 0.783 and c = 0.782; males: c = 0.796 and c = 0.794 in derivation and validation, respectively) and all scores were poor at predicting bleeding risk.
Conclusions:
A temporally dynamic risk score, IMRS-VASc was derived and validated as a predictor of stroke in outpatients with AF. IMRS-VASc requires further validation and the evaluation of its use in guiding care and treatment decisions for patients with AF.
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