Relationship of Aging and Comorbidities to Stroke Risk in AF

Jan 11, 2018
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Authors:
Chao TF, Lip GY, Liu CJ, et al.
Citation:
Relationship of Aging and Incident Comorbidities to Stroke Risk in Patients With Atrial Fibrillation. J Am Coll Cardiol 2018;71:122-132.
Summary By:
Geoffrey D. Barnes, MD, MSc, FACC

Study Questions:

What is the impact of a change in the CHA2DS2-VASc score over time and the risk of ischemic stroke in patients with atrial fibrillation (AF)?

Methods:

The authors studied 31,039 AF patients from the Taiwan National Health Insurance system who were not treated with antiplatelet agents or oral anticoagulants and without any CHA2DS2-VASc risk elements other than age or sex. These patients were followed for the development of any new CHA2DS2-VASc risk factors (e.g., hypertension, diabetes). A change in the CHA2DS2-VASc scores was assessed for the risk of subsequent ischemic stroke. Predictive ability for ischemic stroke was compared using the C-statistic and net reclassification index.

Results:

Mean CHA2DS2-VASc scores were 1.29 at baseline, which increased to 2.31 over the 171,956 person-years of follow-up (mean change in CHA2DS2-VASc score of 1.02). Among the 4,103 patients who experienced an ischemic stroke, 89.4% had an increase in CHA2DS2-VASc of ≥1, compared to only 54.6% of patients without an ischemic stroke (p < 0.001). The most common new comorbidity was hypertension. A change in CHA2DS2-VASc score was a better predictor of ischemic stroke than baseline or follow-up CHA2DS2-VASc score.

Conclusions:

The authors concluded that the CHA2DS2-VASc score is not static and that most patients develop ≥1 new CHA2DS2-VASc comorbidities. The authors also concluded that an increase in CHA2DS2-VASc score is associated with an increased risk of ischemic stroke, perhaps as a better predictor of stroke than the CHA2DS2-VASc score itself.

Perspective:

This study leverages a large, national health data set to explore the impact of stroke risk factors on subsequent ischemic stroke risk in patients with AF. Important findings for practicing clinicians are that the CHA2DS2-VASc score does not remain static and should be periodically re-calculated. Additionally, patients who develop new risk factors (e.g., hypertension) may be at increased risk for ischemic stroke, highlighting the importance of prophylactic anticoagulation.

Keywords: Aging, Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Comorbidity, Diabetes Mellitus, Hypertension, Platelet Aggregation Inhibitors, Primary Prevention, Risk Factors, Stroke, Vascular Diseases


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