Author + information
- Received July 3, 2014
- Revision received September 26, 2014
- Accepted October 7, 2014
- Published online January 27, 2015.
- ∗Karolinska Institute, Department of Clinical Sciences at Danderyd Hospital and Department of Cardiology at Danderyd Hospital, Stockholm, Sweden
- †Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
- ↵∗Reprint requests and correspondence:
Dr. Leif Friberg, Karolinska Institutet at Danderyd Hospital, Hjärtkliniken, Danderyds sjukhus AB, SE-182 88 Stockholm, Sweden.
Background Patients with atrial fibrillation (AF) and ≥1 point on the stroke risk scheme CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65–74 years, sex category) are considered at increased risk for future stroke, but the risk associated with a score of 1 differs markedly between studies.
Objectives The goal of this study was to assess AF-related stroke risk among patients with a score of 1 on the CHA2DS2-VASc.
Methods We conducted this retrospective study of 140,420 patients with AF in Swedish nationwide health registries on the basis of varying definitions of “stroke events.”
Results Using a wide “stroke” diagnosis (including hospital discharge diagnoses of ischemic stroke as well as unspecified stroke, transient ischemic attack, and pulmonary embolism) yielded a 44% higher annual risk than if only ischemic strokes were counted. Including stroke events in conjunction with the index hospitalization for AF doubled the long-term risk beyond the first 4 weeks. For women, annual stroke rates varied between 0.1% and 0.2% depending on which event definition was used; for men, the corresponding rates were 0.5% and 0.7%.
Conclusions The risk of ischemic stroke in patients with AF and a CHA2DS2-VASc score of 1 seems to be lower than previously reported.
This study was supported by the Swedish Heart and Lung Foundation, the Stockholm County Council, the Swedish Society of Medicine, and the Board of Benevolence of the Swedish Order of Freemasons. Dr. Friberg has received research grants and/or given lectures (without relation to the present study) for Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Sanofi, and St. Jude Medical. Dr. Terént has received a research grant from AstraZeneca AB. Dr. Skeppholm has reported that he has no relationships relevant to the contents of this paper to disclose.
- Received July 3, 2014.
- Revision received September 26, 2014.
- Accepted October 7, 2014.
- American College of Cardiology Foundation