Dynamic Changes of CHA 2 DS 2 -VASc Score and the Risk of Ischaemic Stroke in Asian Patients with Atrial Fibrillation: A Nationwide Cohort Study

Minjae Yoon, Pil Sung Yang, Eunsun Jang, Hee Tae Yu, Tae Hoon Kim, Jae Sun Uhm, Jong Youn Kim, Hui Nam Pak, Moon Hyoung Lee, Gregory Y.H. Lip, Boyoung Joung

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background Stroke risk in atrial fibrillation (AF) is often assessed at initial presentation, and risk stratification performed as a 'one off'. In validation studies of risk prediction, baseline values are often used to 'predict' events that occur many years later. Many clinical variables have 'dynamic' changes over time, as the patient is followed up. These dynamic changes in risk factors may increase the CHA 2 DS 2 -VASc score, stroke risk category and absolute ischaemic stroke rate. Objective This article evaluates the 'dynamic' changes of CHA 2 DS 2 -VASc variables and its effect on prediction of stroke risk. Patients and Methods From the Korea National Health Insurance Service database, a total of 167,262 oral anticoagulant-naive non-valvular AF patients aged ≥ 18 years old were enrolled between January 1, 2002, and December 31, 2005. These patients were followed up until December 31, 2015. Results At baseline, the proportions of subjects categorized as 'low', 'intermediate' or 'high risk' by CHA 2 DS 2 -VASc score were 15.4, 10.6 and 74.0%, respectively. Mean CHA 2 DS 2 -VASc score increased annually by 0.14, particularly due to age and hypertension. During follow-up of 10 years, 46.6% of 'low-risk' patients and 72.0% of 'intermediate risk' patients were re-classified to higher stroke risk categories. Among the original 'low-risk' patients, annual ischaemic stroke rates were significantly higher in the re-classified 'intermediate' (1.17 per 100 person-years, p < 0.001) or re-classified 'high-risk' groups (1.44 per 100 person-years, p = 0.048) than consistently 'low-risk' group (0.29 per 100 person-years). The most recent CHA 2 DS 2 -VASc score and the score change with the longest follow-up had the best prediction for ischaemic stroke. Conclusion In AF patients, stroke risk as assessed by the CHA 2 DS 2 -VASc score is dynamic and changes over time. Rates of ischaemic stroke increased when patients accumulated risk factors, and were re-classified into higher CHA 2 DS 2 -VASc score categories. Stroke risk assessment is needed at every patient contact, as accumulation of risk factors with increasing CHA 2 DS 2 -VASc score translates to greater stroke risks over time.

Original languageEnglish
Pages (from-to)1296-1304
Number of pages9
JournalThrombosis and Haemostasis
Volume118
Issue number7
DOIs
Publication statusPublished - 2018 Jul 1

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Atrial Fibrillation
Cohort Studies
Stroke
National Health Programs
Validation Studies
Korea
Anticoagulants
Databases
Hypertension

All Science Journal Classification (ASJC) codes

  • Hematology

Cite this

Yoon, Minjae ; Yang, Pil Sung ; Jang, Eunsun ; Yu, Hee Tae ; Kim, Tae Hoon ; Uhm, Jae Sun ; Kim, Jong Youn ; Pak, Hui Nam ; Lee, Moon Hyoung ; Lip, Gregory Y.H. ; Joung, Boyoung. / Dynamic Changes of CHA 2 DS 2 -VASc Score and the Risk of Ischaemic Stroke in Asian Patients with Atrial Fibrillation : A Nationwide Cohort Study. In: Thrombosis and Haemostasis. 2018 ; Vol. 118, No. 7. pp. 1296-1304.
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title = "Dynamic Changes of CHA 2 DS 2 -VASc Score and the Risk of Ischaemic Stroke in Asian Patients with Atrial Fibrillation: A Nationwide Cohort Study",
abstract = "Background Stroke risk in atrial fibrillation (AF) is often assessed at initial presentation, and risk stratification performed as a 'one off'. In validation studies of risk prediction, baseline values are often used to 'predict' events that occur many years later. Many clinical variables have 'dynamic' changes over time, as the patient is followed up. These dynamic changes in risk factors may increase the CHA 2 DS 2 -VASc score, stroke risk category and absolute ischaemic stroke rate. Objective This article evaluates the 'dynamic' changes of CHA 2 DS 2 -VASc variables and its effect on prediction of stroke risk. Patients and Methods From the Korea National Health Insurance Service database, a total of 167,262 oral anticoagulant-naive non-valvular AF patients aged ≥ 18 years old were enrolled between January 1, 2002, and December 31, 2005. These patients were followed up until December 31, 2015. Results At baseline, the proportions of subjects categorized as 'low', 'intermediate' or 'high risk' by CHA 2 DS 2 -VASc score were 15.4, 10.6 and 74.0{\%}, respectively. Mean CHA 2 DS 2 -VASc score increased annually by 0.14, particularly due to age and hypertension. During follow-up of 10 years, 46.6{\%} of 'low-risk' patients and 72.0{\%} of 'intermediate risk' patients were re-classified to higher stroke risk categories. Among the original 'low-risk' patients, annual ischaemic stroke rates were significantly higher in the re-classified 'intermediate' (1.17 per 100 person-years, p < 0.001) or re-classified 'high-risk' groups (1.44 per 100 person-years, p = 0.048) than consistently 'low-risk' group (0.29 per 100 person-years). The most recent CHA 2 DS 2 -VASc score and the score change with the longest follow-up had the best prediction for ischaemic stroke. Conclusion In AF patients, stroke risk as assessed by the CHA 2 DS 2 -VASc score is dynamic and changes over time. Rates of ischaemic stroke increased when patients accumulated risk factors, and were re-classified into higher CHA 2 DS 2 -VASc score categories. Stroke risk assessment is needed at every patient contact, as accumulation of risk factors with increasing CHA 2 DS 2 -VASc score translates to greater stroke risks over time.",
author = "Minjae Yoon and Yang, {Pil Sung} and Eunsun Jang and Yu, {Hee Tae} and Kim, {Tae Hoon} and Uhm, {Jae Sun} and Kim, {Jong Youn} and Pak, {Hui Nam} and Lee, {Moon Hyoung} and Lip, {Gregory Y.H.} and Boyoung Joung",
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Dynamic Changes of CHA 2 DS 2 -VASc Score and the Risk of Ischaemic Stroke in Asian Patients with Atrial Fibrillation : A Nationwide Cohort Study. / Yoon, Minjae; Yang, Pil Sung; Jang, Eunsun; Yu, Hee Tae; Kim, Tae Hoon; Uhm, Jae Sun; Kim, Jong Youn; Pak, Hui Nam; Lee, Moon Hyoung; Lip, Gregory Y.H.; Joung, Boyoung.

In: Thrombosis and Haemostasis, Vol. 118, No. 7, 01.07.2018, p. 1296-1304.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Dynamic Changes of CHA 2 DS 2 -VASc Score and the Risk of Ischaemic Stroke in Asian Patients with Atrial Fibrillation

T2 - A Nationwide Cohort Study

AU - Yoon, Minjae

AU - Yang, Pil Sung

AU - Jang, Eunsun

AU - Yu, Hee Tae

AU - Kim, Tae Hoon

AU - Uhm, Jae Sun

AU - Kim, Jong Youn

AU - Pak, Hui Nam

AU - Lee, Moon Hyoung

AU - Lip, Gregory Y.H.

AU - Joung, Boyoung

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Background Stroke risk in atrial fibrillation (AF) is often assessed at initial presentation, and risk stratification performed as a 'one off'. In validation studies of risk prediction, baseline values are often used to 'predict' events that occur many years later. Many clinical variables have 'dynamic' changes over time, as the patient is followed up. These dynamic changes in risk factors may increase the CHA 2 DS 2 -VASc score, stroke risk category and absolute ischaemic stroke rate. Objective This article evaluates the 'dynamic' changes of CHA 2 DS 2 -VASc variables and its effect on prediction of stroke risk. Patients and Methods From the Korea National Health Insurance Service database, a total of 167,262 oral anticoagulant-naive non-valvular AF patients aged ≥ 18 years old were enrolled between January 1, 2002, and December 31, 2005. These patients were followed up until December 31, 2015. Results At baseline, the proportions of subjects categorized as 'low', 'intermediate' or 'high risk' by CHA 2 DS 2 -VASc score were 15.4, 10.6 and 74.0%, respectively. Mean CHA 2 DS 2 -VASc score increased annually by 0.14, particularly due to age and hypertension. During follow-up of 10 years, 46.6% of 'low-risk' patients and 72.0% of 'intermediate risk' patients were re-classified to higher stroke risk categories. Among the original 'low-risk' patients, annual ischaemic stroke rates were significantly higher in the re-classified 'intermediate' (1.17 per 100 person-years, p < 0.001) or re-classified 'high-risk' groups (1.44 per 100 person-years, p = 0.048) than consistently 'low-risk' group (0.29 per 100 person-years). The most recent CHA 2 DS 2 -VASc score and the score change with the longest follow-up had the best prediction for ischaemic stroke. Conclusion In AF patients, stroke risk as assessed by the CHA 2 DS 2 -VASc score is dynamic and changes over time. Rates of ischaemic stroke increased when patients accumulated risk factors, and were re-classified into higher CHA 2 DS 2 -VASc score categories. Stroke risk assessment is needed at every patient contact, as accumulation of risk factors with increasing CHA 2 DS 2 -VASc score translates to greater stroke risks over time.

AB - Background Stroke risk in atrial fibrillation (AF) is often assessed at initial presentation, and risk stratification performed as a 'one off'. In validation studies of risk prediction, baseline values are often used to 'predict' events that occur many years later. Many clinical variables have 'dynamic' changes over time, as the patient is followed up. These dynamic changes in risk factors may increase the CHA 2 DS 2 -VASc score, stroke risk category and absolute ischaemic stroke rate. Objective This article evaluates the 'dynamic' changes of CHA 2 DS 2 -VASc variables and its effect on prediction of stroke risk. Patients and Methods From the Korea National Health Insurance Service database, a total of 167,262 oral anticoagulant-naive non-valvular AF patients aged ≥ 18 years old were enrolled between January 1, 2002, and December 31, 2005. These patients were followed up until December 31, 2015. Results At baseline, the proportions of subjects categorized as 'low', 'intermediate' or 'high risk' by CHA 2 DS 2 -VASc score were 15.4, 10.6 and 74.0%, respectively. Mean CHA 2 DS 2 -VASc score increased annually by 0.14, particularly due to age and hypertension. During follow-up of 10 years, 46.6% of 'low-risk' patients and 72.0% of 'intermediate risk' patients were re-classified to higher stroke risk categories. Among the original 'low-risk' patients, annual ischaemic stroke rates were significantly higher in the re-classified 'intermediate' (1.17 per 100 person-years, p < 0.001) or re-classified 'high-risk' groups (1.44 per 100 person-years, p = 0.048) than consistently 'low-risk' group (0.29 per 100 person-years). The most recent CHA 2 DS 2 -VASc score and the score change with the longest follow-up had the best prediction for ischaemic stroke. Conclusion In AF patients, stroke risk as assessed by the CHA 2 DS 2 -VASc score is dynamic and changes over time. Rates of ischaemic stroke increased when patients accumulated risk factors, and were re-classified into higher CHA 2 DS 2 -VASc score categories. Stroke risk assessment is needed at every patient contact, as accumulation of risk factors with increasing CHA 2 DS 2 -VASc score translates to greater stroke risks over time.

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