Prestroke CHA2DS2-VASc Score Predicts Stroke Severity, Outcomes

atrial fibrillation
atrial fibrillation
Clinicians should closely monitor patients with atrial fibrillation, especially if they are female and of increasing age.

Prestroke CHA2DS2-VASc score correlates with stroke severity, as well as disability and mortality at 90 days, among patients with atrial fibrillation (AF) and acute ischemic stroke, according to a study published in the Journal of Stroke and Cerebrovascular Diseases.

The CHA2DS2-VASc score is used to estimate the risk for ischemic stroke in patients with AF. Retrospective data suggest that the prestroke CHA2DS2-VASc score predicts large vessel occlusion in patients with AF and acute ischemic stroke, and that the CHA2DS2-VASc score may also be associated with stroke severity and functional outcome.

Researchers examined the relationship between prestroke CHA2DS2-VASc score and stroke severity and functional outcome in patients with AF and acute ischemic stroke who were prospectively enrolled in the database of the acute stroke and AF study (RAF study). Stroke severity was measured with the National Institutes of Health Stroke Scale, and disability and mortality were assessed using the modified Rankin Scale.

Of 1020 patients, approximately 40%  had severe stroke (National Institutes of Health Stroke Scale ≥10) and 50% had adverse functional outcome (modified Rankin Scale ≥3) at 90 days.

Higher prestroke CHA2DS2-VASc scores correlated with greater stroke severity in a linear fashion (odds ratio [OR], 1.084 for every 1-point increase; P =.041). Of the components of the CHA2DS2-VASc score, female sex and increasing age predicted more severe stroke. CHA2DS2-VASc score was also associated with stroke lesion size.

Prestroke CHA2DS2-VASc score also predicted the risk for 90-day disability and mortality (modified Rankin Scale ≥3; odds ratio, 1.278 for every 1-point increase; P =.001). Admission National Institutes of Health Stroke Scale score correlated with adverse functional outcome as well (odds ratio, 1.236 for every 1-point increase; P <.0001).

“In conclusion, we found that an increasing CHA2DS2-VASc score in AF patients predicted a more severe stroke at presentation, leading to a higher rate of disability and mortality at 90 days. This result highlights the need for physicians to more regularly investigate for AF in patients with other known vascular risk factors, especially increasing age and female sex,” the researchers wrote.

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Acciarresi M, Paciaroni M, Agnelli G, et al. Prestroke CHA2DS2-VASc score and severity of acute stroke in patients with atrial fibrillation: findings from RAF study [published online February 21, 2017]. J Stroke Cerebrovasc Dis. doi: 10.1016/j.jstrokecerebrovasdis.2017.02.011