Does CHA2DS2-VASc Improve Stroke Risk Stratification in Postmenopausal Women with Atrial Fibrillation?

JoEllyn M Abraham; Joseph Larson; Mina K Chung; Anne B Curtis; Kamakshi Lakshminarayan; Jonathan D Newman; Marco Perez; Kathryn Rexrode; Nawar M Shara; Allen J Solomon; Marcia L Stefanick; James C Torner; Bruce L Wilkoff; Sylvia Wassertheil-Smoller

doi:10.1016/j.amjmed.2013.05.023

Back

Does CHA2DS2-VASc Improve Stroke Risk Stratification in Postmenopausal Women with Atrial Fibrillation?

Journal article

Peer reviewed

Does CHA2DS2-VASc Improve Stroke Risk Stratification in Postmenopausal Women with Atrial Fibrillation?

JoEllyn M Abraham, Joseph Larson, Mina K Chung, Anne B Curtis, Kamakshi Lakshminarayan, Jonathan D Newman, Marco Perez, Kathryn Rexrode, Nawar M Shara, Allen J Solomon, …

The American journal of medicine, Vol.126(12), pp.1143.e1-1143.e8

12/2013

DOI: 10.1016/j.amjmed.2013.05.023

PMCID: PMC3883047

PMID: 24139523

Files and links (1)

url

https://www.ncbi.nlm.nih.gov/pmc/articles/3883047View

Open Access

Abstract

Risk stratification of atrial fibrillation patients with a congestive heart failure (C), hypertension (H), age ≥ 75 (A), diabetes (D), stroke or transient ischemic attack (TIA) (S2) (CHADS2) score of <2 remains imprecise, particularly in women. Our objectives were to validate the CHADS2 and congestive heart failure (C), hypertension (H), age ≥ 75 (A2), diabetes (D), stroke, TIA or prior thromboembolic disease (S2)- vascular disease (V), age 65-74 (A), female gender (S) (CHA2DS2-VASc) stroke risk scores in a healthy cohort of American women with atrial fibrillation and to determine whether CHA2DS2-VASc further risk-stratifies individuals with a CHADS2 score of <2. We identified a cohort of 5981 women with atrial fibrillation not on warfarin at baseline (mean age 65.9 ± 7.2 years) enrolled in the Women's Health Initiative and followed for a median of 11.8 years. Univariate and multivariate proportional hazards analyses were used to examine these 2 risk scores, with main outcome measures being annualized event rates of ischemic stroke or transient ischemic attack stratified by risk score. Annualized stroke/transient ischemic attack rates ranged from 0.36% to 2.43% with increasing CHADS2 score (0-4+) (hazard ratio [HR] 1.57; 95% confidence interval [CI], 1.45-1.71 for each 1-point increase) and 0.20%-2.02% with increasing CHA2DS2-VASc score (1-6+) (HR 1.50; 95% CI, 1.41-1.60 for each 1-point increase). CHA2DS2-VASc had a higher c statistic than CHADS2: 0.67 (95% CI, 0.65-0.69) versus 0.65 (95% CI, 0.62-0.67), P <.01. For CHADS2 scores <2, stroke risk almost doubled with every additional CHA2DS2-VASc point. Although both CHADS2, and CHA2DS2-VASc are predictive of stroke risk in postmenopausal women with atrial fibrillation, CHA2DS2-VASc further risk-stratifies patients with a CHADS2 score <2.

Women

Stroke

Atrial fibrillation

CHA2DS2-VASc

CHADS2

Details

Title: Subtitle: Does CHA2DS2-VASc Improve Stroke Risk Stratification in Postmenopausal Women with Atrial Fibrillation?
Creators: JoEllyn M Abraham - Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
Joseph Larson - Women's Health Initiative, Seattle, Wash
Mina K Chung - Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
Anne B Curtis - Department of Medicine, State University of New York, Buffalo
Kamakshi Lakshminarayan - Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
Jonathan D Newman - Department of Cardiovascular Medicine, Columbia University, New York, NY
Marco Perez - Department of Cardiovascular Medicine, Stanford University, Stanford, Calif
Kathryn Rexrode - Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
Nawar M Shara - Department of Biostatistics, MedStar Health Research Institute/Georgetown-Howard Center for Clinical and Translational Sciences, Washington, DC
Allen J Solomon - Division of Cardiology, George Washington University, Washington, DC
Marcia L Stefanick - Department of Medicine, Stanford University, Stanford, Calif
James C Torner - Department of Epidemiology, University of Iowa, Iowa City
Bruce L Wilkoff - Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
Sylvia Wassertheil-Smoller - Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
Resource Type: Journal article
Publication Details: The American journal of medicine, Vol.126(12), pp.1143.e1-1143.e8
DOI: 10.1016/j.amjmed.2013.05.023
PMID: 24139523
PMCID: PMC3883047
NLM abbreviation: Am J Med
ISSN: 0002-9343
eISSN: 1555-7162
Publisher: Elsevier Inc
Grant note: National Institutes of Health National Heart, Lung, and Blood Institute US Department of Health and Human Services
Language: English
Date published: 12/2013
Academic Unit: Epidemiology; Surgery; Injury Prevention Research Center; Neurosurgery
Record Identifier: 9983996190002771

Metrics

22 Record Views

12 Times Cited - Web of Science