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The CHADS2 score is widely used to assess the risk of thromboembolic events in patients with atrial fibrillation (AF). Patients with score of 0-1 are considered ‘low risk’ and are often treated with aspirin alone. The CHA2DS2-VASc, which incorporates 3 additional risk factors, has been shown to identify high-risk subgroups among patients with CHADS2 score of 0-1 in a Danish study. Risk of stroke ranges from 0.84% to 8.18% per year depending on CHA2DS2-VASc score. This study seeks to evaluate significance of using CHA2DS2-VASc score to identify high risk subset of patients with low CHADS2 scores in the United States.
This pilot study examined data from our cardiology fellowship ambulatory clinics from January 2009 to May 2012 using the NCDR-PINNACLE registry. Each cardiology fellow entered his/her patients’ data using on-line software developed by the American College of Cardiology, assisted by our fellowship program.
Among 2,048 patients followed at our clinics, 465 had AF. Of those, 176 patients had a ‘low-risk’ CHADS2 score of 0 (47 patients) or 1 (129 patients). Calculating the CHA2DS2-VASc score in these patients, 12 (6.8%) had a score of 0, 57 (32.4%) had a score of 1, 71(40.3%) had a score of 2, 34 (19.3%) had a score of 3 and 2 (1.1%) had a score of 4. Using the original CHADS2 recommendation, warfarin would not be strongly recommended in any of these patients. Utilizing the CHA2DS2-VASc score, 60.7% of the 176 patients would have a score of 2, 3 or 4 signifying increased cardioembolic risk where anticoagulation may be indicated.
CHA2DS2-VASc may serve as a better tool to assess risk of stroke and anticoagulation strategy in patients with AF with low CHADS2 score. A larger study is needed to assess the implication of application of CHA2DS2-VASc score and risk of stroke in the U.S. population.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias: AF/SVT VIII
Abstract Category: 4. Arrhythmias: AF/SVT
Presentation Number: 1237-43
- 2013 American College of Cardiology Foundation