TY - JOUR

T1 - Assessing absolute stroke risk in patients with atrial fibrillation using a risk factor-based approach

AU - Lee, Christina J-Y

AU - Toft-Petersen, Anne Pernille

AU - Ozenne, Brice

AU - Phelps, Matthew

AU - Olesen, Jonas Bjerring

AU - Ellinor, Patrick T.

AU - Gislason, Gunnar

AU - Lip, Gregory Y. H.

AU - Torp-Pedersen, Christian

AU - Gerds, Thomas Alexander

PY - 2021

Y1 - 2021

N2 - Aim To assess the risk of stroke and thromboembolism in patients with atrial fibrillation (AF) based on risk factor com- binations of the CHA(2)DS(2)-VASc score.Methods and results Using nationwide Danish registries, patients with AF were included from 1997 to 2015 in this retrospective observational study. A multiple logistic regression, including interactions of history of stroke with age at AF, calendar year of AF, and the CHA(2)DS(2)-VASc score risk factors (congestive heart failure, hypertension, diabetes, vascular disease, and female sex) were used to predict the personalized risks of stroke within 1 year. A total of 147 842 patients with AF were included in the study cohort (median age 76 years, range 20-100 years, 51% females). Within the first year, 6% of the cohort were diagnosed with stroke. The predicted personalized 1-year absolute risk of stroke varied widely within each CHA(2)DS(2)-VASc score. To estimate the personalized risk of stroke an online calculator was created, the Calculator of Absolute Stroke Risk (CARS), which allows calculation of all the possible combinations of the CHA(2)DS(2)-VASc score (https://hjerteforeningen.shinyapps.io/riskvisrr/).Conclusion Calculation of the individual risk using a risk factor-based approach as opposed to using average risk for a particular CHA(2)DS(2)-VASc score can improve risk estimates. Furthermore, CARS can assist in the communication of the stroke risk for a more evidence-based shared decision-making of whether to initiate oral anticoagulation therapy.

AB - Aim To assess the risk of stroke and thromboembolism in patients with atrial fibrillation (AF) based on risk factor com- binations of the CHA(2)DS(2)-VASc score.Methods and results Using nationwide Danish registries, patients with AF were included from 1997 to 2015 in this retrospective observational study. A multiple logistic regression, including interactions of history of stroke with age at AF, calendar year of AF, and the CHA(2)DS(2)-VASc score risk factors (congestive heart failure, hypertension, diabetes, vascular disease, and female sex) were used to predict the personalized risks of stroke within 1 year. A total of 147 842 patients with AF were included in the study cohort (median age 76 years, range 20-100 years, 51% females). Within the first year, 6% of the cohort were diagnosed with stroke. The predicted personalized 1-year absolute risk of stroke varied widely within each CHA(2)DS(2)-VASc score. To estimate the personalized risk of stroke an online calculator was created, the Calculator of Absolute Stroke Risk (CARS), which allows calculation of all the possible combinations of the CHA(2)DS(2)-VASc score (https://hjerteforeningen.shinyapps.io/riskvisrr/).Conclusion Calculation of the individual risk using a risk factor-based approach as opposed to using average risk for a particular CHA(2)DS(2)-VASc score can improve risk estimates. Furthermore, CARS can assist in the communication of the stroke risk for a more evidence-based shared decision-making of whether to initiate oral anticoagulation therapy.

KW - Atrial fibrillation

KW - Anticoagulation therapy

KW - CHA(2)DS(2)-VASC score

KW - Personalized risk

KW - Stroke

KW - Thromboembolism

KW - NATIONAL REGISTRY

KW - FEMALE SEX

KW - VALIDITY

KW - GENDER

KW - MODELS

KW - HEALTH

KW - SCORE

U2 - 10.1093/ehjcvp/pvaa063

DO - 10.1093/ehjcvp/pvaa063

M3 - Journal article

C2 - 32531029

VL - 7

SP - F3-F10

JO - European Heart Journal - Cardiovascular Pharmacotherapy

JF - European Heart Journal - Cardiovascular Pharmacotherapy

SN - 2055-6837

IS - F11

ER -