Should CHA2DS2-VASc Be Reassessed More Frequently to Improve Stroke Prevention in Afib?
These results suggest that CHA2DS2-VASc scores should be continually reassessed, perhaps annually, in patients with atrial fibrillation.
Patients with atrial fibrillation (AF) who have initial CHA2DS2-VASc scores of 0 (for men) and 1 (for women) should have scores reassessed periodically to determine if oral anticoagulants (OACs) should be prescribed, according to results published in Annals of Internal Medicine.
International guidelines suggest that patients with AF who do not have CHA2DS2-VASc >0 for men or >1 for women can omit OACs. However, the results of this study indicate that patients with AF can acquire more comorbidities over time.
The study included 14,606 participants with newly-diagnosed AF and a CHA2DS2-VASc score of 0 for men (n=8745) or 1 for women (n=5861) who did not receive antiplatelets or OACs from the Taiwan National Health Insurance Research Database (NHRID) from January 1, 1997 to December 31, 2010.
The researchers based the acquisition of incident comorbidities increase in CHA2DS2-VASc score on whether International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9- CM) codes for the comorbidities were registered in NHIRD by clinicians who cared for the participants.
The primary endpoint was an increase in a CHA2DS2-VASc score to at least 1 for men and 2 for women. Participants were followed until occurrence of ischemic stroke or death, initiation of antiplatelets of OACs, 7 years after incident AF, or on December 31, 2011, whichever came first.
During a mean follow-up of 3.24 years (47,275 total person-years), 36.3% (n=5301) of participants with AF acquired at least 1 new risk factor. Among men, the cumulative incidence of an increase in CHA2DS2-VASc score to ≥1 was 16.1% at 1 year, 24.5% at 2 years, and 49.1% at 7 years.
Among women, the cumulative incidence of an increase in CHA2DS2-VASc score to ≥2 was 16.2% at 1 year, 24.9% at 2 years, and 49.9% at 7 years.
“We propose that CHA2DS2-VASc scores should be reassessed at least annually in patients with AF so that OACs can be prescribed in a timely manner for stroke prevention,” the researchers wrote.
Chao T, Chiang C, Chen T, Lip GYH, Chen S, et al. Reassessment of risk for stroke during follow-up of patients with atrial fibrillation [published online December 31, 20180. Ann Intern Med. doi: 10.7326/M18-1177