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Effect of Race on Stroke Prediction in Atrial Fibrillation
Study Questions:
Does race/ethnicity affect the accuracy of the CHA2DS2-VASc score for predicting ischemic stroke (IS) in patients with atrial fibrillation (AF)?
Methods:
This was a retrospective analysis of an administrative claims database containing 267,419 patients with AF (mean age, 73.1 years). The rates of IS and transient ischemic attacks (TIAs) were determined along with the predictive value of the CHA2DS2-VASc score and interactions with race/ethnicity during a mean of 22 months of follow-up.
Results:
This group of patients was 84.2% white, 8.5% black, and 7.3% Hispanic. The incidence of IS/TIA was higher among blacks (1.65/100 person-years) than whites and Hispanics (1.22 and 1.40/100 person-years, respectively). The IS/TIA incidence rose with higher CHA2DS2-VASc scores and there was no interaction with race/ethnicity. The predictive value of the CHA2DS2-VASc score was not improved by factoring in race/ethnicity.
Conclusions:
The predictive value of the CHA2DS2-VASc score is not affected by race/ethnicity.
Perspective:
Given the higher stroke rate among blacks with AF reported in this and in prior studies, it is reassuring to know that the CHA2DS2-VASc score is equally reliable among all three major races/ethnicities in the United States. The results suggest that the higher stroke rate among blacks may be at least in part due to underutilization of anticoagulants.
Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Prevention, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: African Americans, Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Brain Ischemia, Ethnic Groups, Hispanic Americans, Ischemic Attack, Transient, Primary Prevention, Stroke, Vascular Diseases
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