Improving Stroke Risk Stratification Using the CHADS 2 and CHA 2 DS 2 -VASc Risk Scores in Patients With Paroxysmal Atrial Fibrillation by Continuous Arrhythmia Burden Monitoring
- 1 June 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 42 (6), 1768-1770
- https://doi.org/10.1161/strokeaha.110.609297
Abstract
Background and Purpose—: In patients with atrial fibrillation (AF), stroke risk stratification schema do not consider AF parameters. The aim of the study is to assess the impact of combining risk factors with continuous AF burden monitoring. Methods—: In this retrospective study 568 patients implanted with a DDDR-P pacemaker (AT-500; Medtronic) and a history of AF were continuously monitored for 1 year. Results—: During follow-up, 14 patients (2.5%) had a thromboembolic event. Patients were divided into 3 groups: AF burden ≤5 minutes per day (AF-free; n=223 [39%]), AF burden >5 minutes but 2 and CHA 2 DS 2 -VASc risk scores. The discrimination ability of each risk score was evaluated performing a logistic regression analysis and calculating the corresponding C-statistic. The addition of AF burden improved C-statistics: for CHADS 2 from 0.653 ( P =0.051) to 0.713 ( P =0.007); for CHA 2 DS 2 -VASc, from 0.898 ( P P 2 DS 2 -VASc score had a high sensitivity to predict thromboembolism. Implementation of device data on AF presence/duration/burden has the potential to contribute to improved clinical risk stratification and should be tested prospectively.Keywords
This publication has 5 references indexed in Scilit:
- Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC)European Heart Journal, 2010
- The Relationship Between Daily Atrial Tachyarrhythmia Burden From Implantable Device Diagnostics and Stroke RiskCirculation: Arrhythmia and Electrophysiology, 2009
- Presence and Duration of Atrial Fibrillation Detected by Continuous Monitoring: Crucial Implications for the Risk of Thromboembolic EventsJournal of Cardiovascular Electrophysiology, 2009
- Monitored Atrial Fibrillation Duration Predicts Arterial Embolic Events in Patients Suffering From Bradycardia and Atrial Fibrillation Implanted With Antitachycardia PacemakersJournal of the American College of Cardiology, 2005
- Long-term risk of recurrent atrial fibrillation as documented by an implantable monitoring device: Implications for optimal patient careJournal of the American College of Cardiology, 2004