COMPARING STROKE RISK SCORES FOR PATIENTS WITH AF
van den Ham HA, Klungel OH, Singer DE, et al. Comparative performance of ATRIA, CHADS2, and CHA2DS2-VASc risk scores predicting stroke in patients with atrial fibrillation: results from a national primary care database. J Am Coll Cardiol. 2015;66(17):1851-1859.
The Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) risk score more accurately identified patients with atrial fibrillation (AF) who were at low risk for stroke than did the CHA2DS2-VASc score, which assigned the same patients to higher-risk categories, in a study of 60,594 patients with AF. Researchers found:
• Event rates for moderate- and high-risk categories for CHA2DS2-VASc were lower than those of the ATRIA and CHADS2.
• Age and previous stroke most strongly predicted ischemic stroke.
• C statistics for the full point scores were 0.70 for the ATRIA risk score, 0.68 for CHADS2, and 0.68 for CHA2DS2-VASc risk score.
• Net reclassification improvement was 0.23 for the ATRIA compared with CHA2DS2-VASc.
• Reclassifying patients with very low stroke risk and AF could prevent overuse of anticoagulants.
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