External Validation of SAFE Score to Predict Atrial Fibrillation Diagnosis after Ischemic Stroke: A Retrospective Multicenter Study

• Published in: Stroke research and treatment Vol. 2023; pp. 6655772 - 8
• Main Authors: Quesada López, Miguel, Amaya Pascasio, Laura, Blanco Madera, Sara, Pagola, Jorge, Vidal de Francisco, Diana, de Celis Ruiz, Elena, Villegas Rodríguez, Inmaculada, Carneado-Ruiz, Joaquín, García-Carmona, Juan Antonio, García Torrecillas, Juan Manuel, López Ferreiro, Ana, Elosua Bayes, Iker, Rigual Bobillo, Ricardo Jaime, López López, María Isabel, Esain González, Íñigo, Ortega Ortega, María Dolores, Blanco Ruiz, Marina, Pérez Ortega, Irene, Lázaro Hernández, Carlos, Fuentes Gimeno, Blanca, Arjona Padillo, Antonio, Martínez Sánchez, Patricia
• Format: Journal Article
• Language: English
• Published: United States Hindawi 07.12.2023; Hindawi Limited; Wiley
• Subjects: Age; Atrial fibrillation; Cardiac arrhythmia; Cardiac patients; Chronic obstructive pulmonary disease; Electrocardiogram; Electrocardiography; Gender; Ischemia; Medical imaging; Medical research; Medicine, Experimental; Neuroimaging; Patients; Peptides; Sleep apnea; Software; Stroke; Stroke (Disease); Stroke patients; Thyroid diseases; Topography; Transient ischemic attack; Validation studies; Variables; Spain
• ISSN: 2090-8105; 2042-0056; 2042-0056
• DOI: 10.1155/2023/6655772

Introduction. The screening for atrial fibrillation (AF) scale (SAFE score) was recently developed to provide a prediction of the diagnosis of AF after an ischemic stroke. It includes 7 items: age≥65 years, bronchopathy, thyroid disease, cortical location of stroke, intracranial large vessel occlusion, NT-ProBNP ≥250 pg/mL, and left atrial enlargement. In the internal validation, a good performance was obtained, with an AUC=0.88 (95% CI 0.84-0.91) and sensitivity and specificity of 83% and 80%, respectively, for scores≥5. The aim of this study is the external validation of the SAFE score in a multicenter cohort. Methods. A retrospective multicenter study, including consecutive patients with ischemic stroke or transient ischemic attack between 2020 and 2022 with at least 24 hours of cardiac monitoring. Patients with previous AF or AF diagnosed on admission ECG were excluded. Results. Overall, 395 patients were recruited for analysis. The SAFE score obtained an AUC=0.822 (95% CI 0.778-0.866) with a sensitivity of 87.2%, a specificity of 65.4%, a positive predictive value of 44.1%, and a negative predictive value of 94.3% for a SAFE score≥5, with no significant gender differences. Calibration analysis in the external cohort showed an absence of significant differences between the observed values and those predicted by the model (Hosmer-Lemeshow’s test 0.089). Conclusions. The SAFE score showed adequate discriminative ability and calibration, so its external validation is justified. Further validations in other external cohorts or specific subpopulations of stroke patients might be required.