Stroke due to atrial fibrillation in a population-based stroke registry (Ludwigshafen Stroke Study) CHADS(2) , CHA(2) DS(2) -VASc score, underuse of oral anticoagulation, and implications for preventive measures

• Published in: European journal of neurology Vol. 20; no. 1; pp. 117 - 123
• Main Authors: Palm, F, Kleemann, T, Dos Santos, M, Urbanek, C, Buggle, F, Safer, A, Hennerici, M G, Becher, H, Zahn, R, Grau, A J
• Format: Journal Article
• Language: English
• Published: England 01.01.2013
• Subjects: Age Factors; Aged; Aged, 80 and over; Anticoagulants - therapeutic use; Atrial Fibrillation - complications; Chi-Square Distribution; Community Health Planning; Female; Humans; Male; Middle Aged; Prospective Studies; Registries; Retrospective Studies; Severity of Illness Index; Stroke - drug therapy; Stroke - etiology
• ISSN: 1468-1331
• DOI: 10.1111/j.1468-1331.2012.03804.x

Atrial fibrillation (AF) is amongst the most important etiologies of ischaemic stroke. In a population-based stroke registry, we tested the hypothesis of low adherence to current guidelines as a main cause of high rates of AF-associated stroke. Within the Ludwigshafen Stroke Study (LuSSt), a prospective ongoing population-based stroke register, we analyzed all patients with a first-ever ischaemic stroke (FEIS) owing to AF in 2006 and 2007. We determined whether AF was diagnosed before stroke and assessed pre-stroke CHADS(2) and CHA(2) DS(2) -VASc scores. In total, 187 of 626 patients with FEIS suffered from cardioembolic stroke owing to AF, which was newly diagnosed in 57 (31%) patients. Retrospective pre-stroke risk stratification according to CHADS(2) score indicated low/intermediate risk in 34 patients (18%) and high risk (CHADS(2)  ≥ 2) in 153 patients (82%). Application of CHA(2) DS(2) -VASc score reduced number of patients at low/intermediate risk (CHA(2) DS(2) -VASc score 0-1) to five patients (2.7%). In patients with a CHADS(2) score ≥ 2 and known AF (n = 106) before stroke, 38 (36%) were on treatment with vitamin K antagonists on admission whilst only in 16 patients (15%) treatment was in therapeutic range. Our study strongly supports the hypothesis that underuse of oral anticoagulants in high-risk patients importantly contributes to AF-associated stroke. CHA(2) DS(2) -VASc score appears to be a more valuable risk stratification tool than CHADS(2) score. Preventive measures should focus on optimizing pre-stroke detection of AF and better implementation of present AF-guidelines with respect to anticoagulation therapy.