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The CHADS2 and CHA2DS2–VASc scores predict new occurrence of atrial fibrillation and ischemic stroke

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Early identification of individuals who are at risk of developing atrial fibrillation (AF) and ischemic stroke may enable a closer surveillance and thus prompt initiation of oral anticoagulation for stroke prevention.

Objective

This study sought to investigate whether congestive heart failure, hypertension, age ≥ 75 years, diabetes, previous stroke (CHADS2) and CHA2DS2–vascular disease, age 65–74 years, sex category (CHA2DS2–VASc) scores can predict new-onset AF and/or ischemic stroke in patients presenting with arrhythmic symptoms.

Methods and results

We prospectively followed up 528 patients (68.5 ± 10.6 years, male 46.2 %) presented for assessment of arrhythmic symptoms but without any documented arrhythmia, including AF for development of new-onset AF and/or ischemic stroke. Their mean CHADS2 and CHA2DS2–VASc scores on presentation were 1.3 ± 1.3 and 2.3 ± 1.5, respectively. After 6.1 years, 89 patients (16.8 %, 2.77 per 100 patient-years) had documented AF, and 65 patients (12.3 %, 2.0 per 100 patient-years) suffered stroke. Both the CHADS2 (C statistic 0.63, 95 % confidence interval (CI) 0.58–0.67, P < 0.0001, optimal cutoff at 1) and CHA2DS2–VASc (C statistic 0.63, 95 % CI 0.59–0.67, P < 0.0001, optimal cutoff at 2) scores provided similar prediction for the new-onset AF. Similarly, CHADS2 (C statistic 0.69, 95 % CI 0.65–0.73, P < 0.0001, optimal cutoff at 2) and CHA2DS2–VASc (C statistic 0.69, 95 % CI 0.65–0.73, P < 0.0001, optimal cutoff at 2) have compatible efficacy for stroke prediction in this Chinese population.

Conclusion

The CHADS2 and CHA2DS2–VASc scores can be used in patients who presented with arrhythmic symptoms to identify those who are at risk with developing new-onset clinical AF and ischemic stroke for close clinical surveillance and early intervention.

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Abbreviations

ACEI:

Angiotensin converting enzyme inhibitor

AF:

Atrial fibrillation

CCB:

Calcium channel blocker

CHADS2 :

Congestive heart failure, hypertension, age ≥ 75 years, diabetes, previous stroke

CHA2DS2–VASc:

CHA2DS2–vascular disease, age 65–74 years, sex category

CI:

Confidence interval

DM:

Diabetes mellitus

ECG:

Electrocardiogram

HR:

Hazard ratio

HT:

Hypertension

LVEF:

Left ventricular ejection fraction

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Authors and Affiliations

  1. Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China

    Ming-Liang Zuo, Shasha Liu, Boon-Hor Chong, Yuk-Fai Lau, Chu-Pak Lau, Hung-Fat Tse & Chung-Wah Siu

  2. Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, SAR, China

    Koon-Ho Chan, Hung-Fat Tse & Chung-Wah Siu

  3. Neurology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China

    Koon-Ho Chan & Kui-Kai Lau

  4. Department of Statistics and Actuarial Science, University of Hong Kong, Hong Kong, SAR, China

    Kwok-Fai Lam

  5. Department of Community Medicine, University of Hong Kong, Hong Kong, SAR, China

    Yap-Hang Chan

  6. University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK

    Gregory Y. H. Lip

Authors
  1. Ming-Liang Zuo
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  2. Shasha Liu
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  3. Koon-Ho Chan
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  4. Kui-Kai Lau
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  5. Boon-Hor Chong
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  6. Kwok-Fai Lam
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  7. Yap-Hang Chan
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  8. Yuk-Fai Lau
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  9. Gregory Y. H. Lip
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  10. Chu-Pak Lau
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  11. Hung-Fat Tse
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  12. Chung-Wah Siu
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Corresponding author

Correspondence to Chung-Wah Siu.

Additional information

Ming-Liang Zuo and Shasha Liu contribute equally.

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Zuo, ML., Liu, S., Chan, KH. et al. The CHADS2 and CHA2DS2–VASc scores predict new occurrence of atrial fibrillation and ischemic stroke. J Interv Card Electrophysiol 37, 47–54 (2013). https://doi.org/10.1007/s10840-012-9776-0

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  • DOI: https://doi.org/10.1007/s10840-012-9776-0

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