Sara Aspberg1, Yuchiao Chang2, Adriano Atterman3, Matteo Bottai4, Alan S Go5,6,7, Daniel E Singer2. 1. Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden sara.aspberg@ds.se. 2. Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. 3. Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden. 4. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. 5. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA. 6. Departments of Epidemiology, Biostatistics and Medicine, University of California at San Francisco, San Francisco, CA, USA. 7. Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA.
Abstract
AIMS: Better stroke risk prediction is needed to optimize the anticoagulation decision in atrial fibrillation (AF). The ATRIA stroke risk score (ATRIA) was developed and validated in two large California community AF cohorts. We compared the performance of the ATRIA, CHADS2, and CHA2DS2-VASc scores in a national Swedish AF (SAF) cohort. METHODS AND RESULTS: We examined all Swedish patients hospitalized, or visiting a hospital-based outpatient clinic, with a diagnosis of AF from July 2005 through December 2010. Variables were determined from comprehensive national databases. Risk scores were assessed via C-index (C) and net reclassification improvement (NRI). The cohort included 152 153 AF patients not receiving warfarin. Overall, 11 053 acute ischaemic strokes were observed with mean rate 3.2%/year, higher than the 2%/year in the California cohorts. Using entire point scores, ATRIA had a good C of 0.708 (0.704-0.713), significantly better than CHADS2 0.690 (0.685-0.695) or CHA2DS2-VASc 0.694 (0.690-0.700). Using published cut-points for low/moderate/high risk, C deteriorated but ATRIA remained superior. Net reclassification improvement favoured ATRIA 0.16 (0.14-0.17) vs. CHADS2 and 0.21 (0.20-0.23) vs. CHA2DS2-VASc. Net reclassification improvement decreased when cut-points were altered to better fit the cohort's stroke rates. CONCLUSION: In this SAF cohort, the ATRIA score predicted ischaemic stroke risk better than CHADS2 or CHA2DS2-VASc. However, relative performance of the categorical scores varied by population stroke rates. Score cut-points may need to be optimized to better fit local population stroke rates. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Better stroke risk prediction is needed to optimize the anticoagulation decision in atrial fibrillation (AF). The ATRIA stroke risk score (ATRIA) was developed and validated in two large California community AF cohorts. We compared the performance of the ATRIA, CHADS2, and CHA2DS2-VASc scores in a national Swedish AF (SAF) cohort. METHODS AND RESULTS: We examined all Swedish patients hospitalized, or visiting a hospital-based outpatient clinic, with a diagnosis of AF from July 2005 through December 2010. Variables were determined from comprehensive national databases. Risk scores were assessed via C-index (C) and net reclassification improvement (NRI). The cohort included 152 153 AFpatients not receiving warfarin. Overall, 11 053 acute ischaemic strokes were observed with mean rate 3.2%/year, higher than the 2%/year in the California cohorts. Using entire point scores, ATRIA had a good C of 0.708 (0.704-0.713), significantly better than CHADS2 0.690 (0.685-0.695) or CHA2DS2-VASc 0.694 (0.690-0.700). Using published cut-points for low/moderate/high risk, C deteriorated but ATRIA remained superior. Net reclassification improvement favoured ATRIA 0.16 (0.14-0.17) vs. CHADS2 and 0.21 (0.20-0.23) vs. CHA2DS2-VASc. Net reclassification improvement decreased when cut-points were altered to better fit the cohort's stroke rates. CONCLUSION: In this SAF cohort, the ATRIA score predicted ischaemic stroke risk better than CHADS2 or CHA2DS2-VASc. However, relative performance of the categorical scores varied by population stroke rates. Score cut-points may need to be optimized to better fit local population stroke rates. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Alan S Go; Kristi Reynolds; Jingrong Yang; Nigel Gupta; Judith Lenane; Sue Hee Sung; Teresa N Harrison; Taylor I Liu; Matthew D Solomon Journal: JAMA Cardiol Date: 2018-07-01 Impact factor: 14.676
Authors: Sachin J Shah; Daniel E Singer; Margaret C Fang; Kristi Reynolds; Alan S Go; Mark H Eckman Journal: Circ Cardiovasc Qual Outcomes Date: 2019-11-11
Authors: Cian P McCarthy; Omair Yousuf; Alvaro Alonso; Elizabeth Selvin; Hugh Calkins; John W McEvoy Journal: Am J Cardiol Date: 2017-02-09 Impact factor: 2.778
Authors: Bory Kea; E Margaret Warton; Dustin W Ballard; Dustin G Mark; Mary E Reed; Adina S Rauchwerger; Steven R Offerman; Uli K Chettipally; Patricia C Ramos; Daphne D Le; David S Glaser; David R Vinson Journal: J Atr Fibrillation Date: 2021-02-28
Authors: David R Vinson; E Margaret Warton; Dustin G Mark; Dustin W Ballard; Mary E Reed; Uli K Chettipally; Nimmie Singh; Sean Z Bouvet; Bory Kea; Patricia C Ramos; David S Glaser; Alan S Go Journal: West J Emerg Med Date: 2018-02-12