The CHADS2 and CHA2DS2–VASc scores predict new occurrence of atrial fibrillation and ischemic stroke

Abstract

Background Early identification of individuals who are at risk of developing atrial fibrillation (AF) and ischemic stroke may enable a closer surveillance and thus prompt initiation of oral anticoagulation for stroke prevention. Objective This study sought to investigate whether congestive heart failure, hypertension, age ≥ 75 years, diabetes, previous stroke (CHADS2) and CHA2DS2–vascular disease, age 65–74 years, sex category (CHA2DS2–VASc) scores can predict new-onset AF and/or ischemic stroke in patients presenting with arrhythmic symptoms. Methods and results We prospectively followed up 528 patients (68.5 ± 10.6 years, male 46.2 %) presented for assessment of arrhythmic symptoms but without any documented arrhythmia, including AF for development of new-onset AF and/or ischemic stroke. Their mean CHADS2 and CHA2DS2–VASc scores on presentation were 1.3 ± 1.3 and 2.3 ± 1.5, respectively. After 6.1 years, 89 patients (16.8 %, 2.77 per 100 patient-years) had documented AF, and 65 patients (12.3 %, 2.0 per 100 patient-years) suffered stroke. Both the CHADS2 (C statistic 0.63, 95 % confidence interval (CI) 0.58–0.67, P < 0.0001, optimal cutoff at 1) and CHA2DS2–VASc (C statistic 0.63, 95 % CI 0.59–0.67, P < 0.0001, optimal cutoff at 2) scores provided similar prediction for the new-onset AF. Similarly, CHADS2 (C statistic 0.69, 95 % CI 0.65–0.73, P < 0.0001, optimal cutoff at 2) and CHA2DS2–VASc (C statistic 0.69, 95 % CI 0.65–0.73, P < 0.0001, optimal cutoff at 2) have compatible efficacy for stroke prediction in this Chinese population. Conclusion The CHADS2 and CHA2DS2–VASc scores can be used in patients who presented with arrhythmic symptoms to identify those who are at risk with developing new-onset clinical AF and ischemic stroke for close clinical surveillance and early intervention.