Dataset Information

Risk of ischemic stroke and utility of CHA₂ DS₂ -VASc score in women and men with atrial fibrillation.

ABSTRACT:

Background

The magnitude of increased risk of stroke in women with atrial fibrillation (AF) remains uncertain.

Hypothesis

We investigated the risk of ischemic stroke and death in women and men with AF, and the risk associated with individual non-sex CHA₂ DS₂ -VASc risk factors.

Methods

Retrospective cohort study of 231?077 (48.1% women) nonselected patients with AF not receiving oral anticoagulation from 2006 to 2014. Data from cross-linked national Swedish registers. The outcome was the first occurrence of ischemic stroke or death. Median age was 82 and 75?years in women and men, respectively. Mean follow-up was 2.5?years.

Results

Hazard ratios, adjusted for non-sex CHA₂ DS₂ -VASc risk factors, for women vs men were 1.53, 95% CI: 1.49-1.58 for ischemic stroke and 1.24, 95% CI: 1.22-1.26 for death, respectively. When divided into age groups the differences in ischemic stroke rates between women and men were attenuated. In patients with only one non-sex CHA₂ DS₂ -VASc risk factor allotted 1 point, ischemic stroke rates per 100 person-years were 1.22 in women (n = 9838) and 1.02 in men (n = 15?609), respectively, P?2 DS₂ -VASc risk factors allotted 1 point.

Conclusions

The risk of ischemic stroke was 1.5-fold higher in women compared to men but this association appears to be the result of confounding by age. In the low risk end, the CHA₂ DS₂ -VASc risk score underestimates the ischemic stroke risk conferred by age 65 to 74?years, while it overestimates the risk conferred by female sex.

SUBMITTER: Tomasdottir M

PROVIDER: S-EPMC6788468 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Risk of ischemic stroke and utility of CHA<sub>2</sub> DS<sub>2</sub> -VASc score in women and men with atrial fibrillation.

Tomasdottir Maria M Friberg Leif L Hijazi Ziad Z Lindbäck Johan J Oldgren Jonas J

Clinical cardiology 20190906 10

<h4>Background</h4>The magnitude of increased risk of stroke in women with atrial fibrillation (AF) remains uncertain.<h4>Hypothesis</h4>We investigated the risk of ischemic stroke and death in women and men with AF, and the risk associated with individual non-sex CHA<sub>2</sub> DS<sub>2</sub> -VASc risk factors.<h4>Methods</h4>Retrospective cohort study of 231 077 (48.1% women) nonselected patients with AF not receiving oral anticoagulation from 2006 to 2014. Data from cross-linked national Sw ...[more]

PMID: 31490011

Similar Datasets

Project description:Background and Purpose- Despite modest predictive ability for ischemic stroke (IS), the CHA2DS2-VASc score is widely used for stroke prediction in atrial fibrillation. Among patients with atrial fibrillation, we aimed to (1) compare the IS or transient ischemic attack (TIA) incidence by CHA2DS2-VASc in blacks and Hispanics versus whites; (2) compare predictive ability of CHA2DS2-VASc score for IS or TIA in blacks and Hispanics versus whites; and (3) determine improvement in predictive ability of CHA2DS2-VASc score from addition of race/ethnicity. Methods- Using data from Optum Clinformatics, a large administrative claims database, we analyzed patients with atrial fibrillation enrolled in commercial and Medicare Advantage health plans from 2009 to 2015. We computed IS or TIA incidence rates, improvement in C statistic, continuous and categorical net reclassification improvement, and relative integrated discrimination improvement from addition of race/ethnicity to CHA2DS2-VASc. Results- A total of 267 419 patients (mean age, 73.1 [SD, 12.3] years; 46.6% women; 84.2% white, 8.5% black, 7.3% Hispanic) were studied. After a mean follow-up of 22 months, there were 6202 IS or TIA events. IS or TIA incidence rates were higher in blacks than Hispanics or whites (1.65, 1.40, and 1.22 cases per 100 person-years, respectively) and increased with higher CHA2DS2-VASc, with no race/ethnicity-based differences (P for interaction=0.17). The CHA2DS2-VASc and CHA2DS2-VASc+race/ethnicity C statistic (95% CI) were 0.679 (0.670-0.686) and 0.679 (0.671-0.688). The CHA2DS2-VASc C statistic in the 3 groups were comparable. With addition of race/ethnicity, the categorical net reclassification improvement, continuous net reclassification improvement, and relative integrated discrimination improvement were -0.045 (95% CI, -0.067 to -0.025), 0.045 (95% CI, 0.025-0.068), and 0.016 (95% CI, 0.014-0.018). Conclusions- The predictive ability of CHA2DS2-VASc for IS or TIA in atrial fibrillation is comparable among whites, blacks, and Hispanics; hence, it can be used in the latter 2 groups. Addition of race/ethnicity to the CHA2DS2-VASc does not improve its predictive ability.

Dataset Information

Risk of ischemic stroke and utility of CHA₂ DS₂ -VASc score in women and men with atrial fibrillation.

Background

Hypothesis

Methods

Results

Conclusions

Publications

Risk of ischemic stroke and utility of CHA<sub>2</sub> DS<sub>2</sub> -VASc score in women and men with atrial fibrillation.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Dataset Information

Risk of ischemic stroke and utility of CHA2 DS2 -VASc score in women and men with atrial fibrillation.

Background

Hypothesis

Methods

Results

Conclusions

Publications

Risk of ischemic stroke and utility of CHA<sub>2</sub> DS<sub>2</sub> -VASc score in women and men with atrial fibrillation.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Risk of ischemic stroke and utility of CHA₂ DS₂ -VASc score in women and men with atrial fibrillation.