Refinement of Ischemic Stroke Risk in Patients with Atrial Fibrillation and CHA 2 DS 2 ‐VASc Score of 1

• Published in: Pacing and clinical electrophysiology Vol. 37; no. 11; pp. 1442 - 1447
• Main Authors: HUANG, DUO, ANGUO, LUO, YUE, WEN‐SHENG, YIN, LIXUE, TSE, HUNG‐FAT, SIU, CHUNG‐WAH
• Format: Journal Article
• Language: English
• Published: 01.11.2014
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/pace.12445

Background  Patients with atrial fibrillation (AF) with CHA 2 DS 2 ‐VASc score of 1 (where CHA 2 DS 2 ‐VASc is CHA 2 DS 2 ‐Vascular disease, Age 65–74 years, Sex category) are recommended to receive antithrombotic therapy. Nonetheless, it remains unclear whether individual components that constitute CHA 2 DS 2 ‐VASc score contribute equally to the ischemic stroke risk, particularly in patients with CHA 2 DS 2 ‐VASc score of 1. The objective was to describe and compare the risk of ischemic stroke of the six individual components constituting CHA 2 DS 2 ‐VASc among AF patients with CHA 2 DS 2 ‐VASc score of 1. Methods and Results We studied all patients with CHA 2 DS 2 ‐VASc score of 1 and no antithrombotic therapy from our cohort of 9,727 Chinese AF patients. A total of 548 patients were studied: 190 patients with CHA 2 DS 2 ‐VASc score of 0 and 358 patients with CHA 2 DS 2 ‐VASc score of 1. Of those with a baseline CHA 2 DS 2 ‐VASc score of 1, 51.1% patients aged 65–75; 29.3% patients were female; 12.0% had hypertension; 4.5% had heart failure; 2.5% had diabetes; and 0.6% had vascular disease. After 1,758 patient‐years of follow‐up, the annual incidence of stroke was 2.4% and 6.6% for patients with CHA 2 DS 2 ‐VASc score of 0 and 1, respectively. Compared with patients with CHA 2 DS 2 ‐VASc score of 0, patients with hypertension leading to CHA 2 DS 2 ‐VASc score of 1 were at the highest risk of stroke (Hazard ratio [HR]: 9.8, 95% confidence interval [CI]: 2.7–35.6), followed by patients aged 65–74 (HR: 3.9, 95% CI: 2.3–6.6) and female gender (HR: 2.3, 95% CI: 1.1–4.8). Heart failure, diabetes mellitus, and vascular disease were not associated with stroke. Conclusion In AF patients with CHA 2 DS 2 ‐VASc score of 1, hypertension confers the highest risk for stroke among other risk factors comprising the score. A more aggressive thromboprophylaxis strategy may be justified among AF patients with CHA 2 DS 2 ‐VASc score of 1 due to hypertension.