In:
Heart and Vessels, Springer Science and Business Media LLC, Vol. 38, No. 10 ( 2023-10), p. 1267-1276
Abstract:
The CHA 2 DS 2 -VASc score is fundamental to stroke risk assessment in atrial fibrillation. However, stroke-related risk factors can be modified later in life. This study aimed to assess the association of changes in CHA 2 DS 2 -VASc score over time (Delta CHA 2 DS 2 -VASc score) with the risk of ischemic stroke. Materials and methods This is an observational analysis of 1127 atrial fibrillation patients previously enrolled in the MISOAC-AF trial. After a median 2.6-year follow-up period, baseline and follow-up CHA 2 DS 2 -VASc scores were used to extract the Delta CHA 2 DS 2 -VASc score. The stroke predicting accuracies of the baseline, follow-up, and Delta CHA 2 DS 2 -VASc scores were assessed through regression analyses. Results The mean baseline, follow-up, and Delta CHA 2 DS 2 -VASc scores were 4.2, 4.8, and 0.6 respectively. Ischemic stroke occurred in 54 (4.4%) patients, of which 83.3% had a Delta CHA 2 DS 2 -VASc score ≥1, contrary to 40.1% of the stroke-free group. The stroke risk per 1-point increase of the CHA 2 DS 2 -VASc score was not significantly associated with the baseline score (aHR=1.14; 95%CI: 0.93-1.41; p =0.201), whereas a significant association was observed with the follow-up (aHR=2.58; 95% CI: 2.07-3.21; p 〈 0.001) and Delta (aHR=4.56; 95%CI: 3.50-5.94; p 〈 0.001) scores. C-index assessment indicated that follow-up and Delta CHA 2 DS 2 -VASc scores were more potent predictors of ischemic stroke compared to baseline. Conclusion In atrial fibrillation patients, changes in CHA 2 DS 2 -VASc score over time were associated with the incidence of stroke. The improved predictability of follow-up and Delta CHA 2 DS 2 -VASc scores indicates that stroke risk is not a static parameter. Trial registration This is an observational, post-hoc analysis of the MISOAC-AF randomized controlled trial, registered on ClinicalTrials.gov (identifier: NCT02941978; registered: October 21, 2016).
Type of Medium:
Online Resource
ISSN:
0910-8327
,
1615-2573
DOI:
10.1007/s00380-023-02278-1
Language:
English
Publisher:
Springer Science and Business Media LLC
Publication Date:
2023
detail.hit.zdb_id:
1481441-9
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