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Atrial Fibrillation in Adult Congenital Heart Increase Ischemic Stroke Risk Even at Low CHA2DS2-VASc Score

Yu-Sheng Lin1,2,3, Yi-Chun Huang1, Chia-Pin Lin1

  • 1Division of Cardiology, Chang Gung Memorial Hospital Linkou Medical Center, 333423 Taoyuan, Taiwan.

Reviews in Cardiovascular Medicine
|July 30, 2024
PubMed

Insights

Adults with congenital heart disease (ACHD) have a significantly higher risk of atrial fibrillation (AF) and subsequent ischemic stroke. Even with low CHA₂DS₂-VASc scores, stroke risk remains elevated in ACHDs with AF.

Area of Science:

  • Cardiology
  • Neurology
  • Public Health

Background:

  • The population of adults with congenital heart disease (ACHD) is growing.
  • Atrial fibrillation (AF) is a significant risk factor for ischemic stroke in ACHDs, but its impact is not well-established.
  • Existing stroke risk scores may not accurately reflect risk in this unique population.

Purpose of the Study:

  • To investigate the prevalence of AF in adults with congenital heart disease.
  • To determine the effect of AF on ischemic stroke incidence in ACHDs.
  • To assess the applicability of the CHA₂DS₂-VASc score for stroke risk stratification in ACHDs.

Main Methods:

  • Retrospective analysis of 36,530 adults with congenital heart disease from 2000-2010 using the Taiwan National Health Insurance Research Database.
  • Comparison of ischemic stroke incidence between ACHDs with and without AF.
  • Evaluation of stroke risk based on age, AF status, and CHA₂DS₂-VASc score, including anticoagulant therapy use.

Main Results:

  • Adults with congenital heart disease exhibited a 4.7-15.3 times higher risk of AF compared to the general population.
  • ACHDs with AF had a 1.45-fold increased risk of ischemic stroke (p=0.009).
  • Ischemic stroke incidence was notably high (>1.47%) even in ACHDs with AF and a low CHA₂DS₂-VASc score (0-1).

Conclusions:

  • Adults with congenital heart disease and AF face an elevated risk of ischemic stroke.
  • The traditional CHA₂DS₂-VASc score may underestimate stroke risk in ACHDs, particularly those with AF.
  • This highlights the need for careful stroke risk management in ACHDs with AF, irrespective of CHA₂DS₂-VASc score.
Abstract

Keywords:
CHA2DS2-VASc scoreadult congenital heart diseaseanticoagulationatrial fibrillationischemic stroke

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