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

  • Ming-Liang Zuo
  • Shasha Liu
  • Koon-Ho Chan
  • Kui-Kai Lau
  • Boon-Hor Chong
  • Kwok-Fai Lam
  • Yap-Hang Chan
  • Yuk-Fai Lau
  • Gregory Y. H. Lip
  • Chu-Pak Lau
  • Hung-Fat Tse
  • Chung-Wah Siu
Article

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.

Keywords

CHADS2 score CHA2DS2–VASc score Atrial fibrillation Stroke 

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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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Ming-Liang Zuo
    • 1
  • Shasha Liu
    • 1
  • Koon-Ho Chan
    • 2
    • 3
  • Kui-Kai Lau
    • 3
  • Boon-Hor Chong
    • 1
  • Kwok-Fai Lam
    • 4
  • Yap-Hang Chan
    • 5
  • Yuk-Fai Lau
    • 1
  • Gregory Y. H. Lip
    • 6
  • Chu-Pak Lau
    • 1
  • Hung-Fat Tse
    • 1
    • 2
  • Chung-Wah Siu
    • 1
    • 2
  1. 1.Cardiology Division, Department of Medicine, Queen Mary HospitalUniversity of Hong KongHong KongChina
  2. 2.Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of MedicineUniversity of Hong KongHong KongChina
  3. 3.Neurology Division, Department of Medicine, Queen Mary HospitalUniversity of Hong KongHong KongChina
  4. 4.Department of Statistics and Actuarial ScienceUniversity of Hong KongHong KongChina
  5. 5.Department of Community MedicineUniversity of Hong KongHong KongChina
  6. 6.University of Birmingham Centre for Cardiovascular SciencesCity HospitalBirminghamUK

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