Abstract Number: PB0014
Meeting: ISTH 2021 Congress
Background: Non-valvular atrial fibrillation (NVAF) patients with low stroke risk require regular re-evaluation of this risk given its dynamic nature. The 2020 ESC guideline for NVAF suggests the first re-evaluation should be made 4-6 months after the index evaluation based on limited evidence.
Aims: To investigate natural changes in CHA2DS2-VASc scores in newly diagnosed NVAF patients with low stroke risk.
Methods: The study used nationwide register data provided by Statistic Netherlands and included newly diagnosed NVAF patients (2013-2018) in the Netherlands with a baseline CHA2DS2-VASc score <2, who were considered to be at low risk of stroke according to current guidelines. Patients were followed from first NVAF diagnosis until the first oral anticoagulant (OAC) prescription, 31/12/2018, or death, whichever came first. CHA2DS2-VASc scores were daily re-evaluated, and the study outcome was a score reaching ≥2. We investigated cumulative incidences and predictors of the outcome by Kaplan-Meier methods and Cox regression analysis.
Results: A total of 50,811 patients were included. The cumulative incidence of developing a CHA2DS2-VASc score ≥2 within 3 months was 1.95% (95%CI 1.71%-2.16%) in male patients with a baseline score of 0, 13.79% (95%CI 12.30%-13.48%) in male patients with a baseline score of 1, and 5.19% (95%CI 4.54%-5.58%) in female patients with a baseline score of 1.
Older age, a baseline HAS-BLED score ≥3 (for female patients), and having a medical history of congestive heart failure or diabetes were associated with an increased risk of developing a CHA2DS2-VASc score ≥2 within 3 months.
Developing a CHA2DS2-VASc score ≥2 within 3 months | Developing a CHA2DS2-VASc score ≥2 within 12 months | |||||||
Male baseline score=0 <65 years |
Male baseline score=1 <65 years |
Male baseline score=1 ≥65 years |
Female baseline score=1 <65 years |
Male baseline score=0 <65 years |
Male baseline score=1 <65 years |
Male baseline score=1 ≥65 years |
Female baseline score=1 <65 years |
|
Age (per year increase) | 1.11 (1.09-1.13) | 1.11 (1.09-1.13) | 1.10 (1.08-1.13) | 1.10 (1.08-1.12) | 1.11 (1.09-1.12) | 1.16 (1.14-1.18) | 1.18 (1.16-1.20) | 1.20 (1.17-1.22) |
HAS-BLED score = 1 (vs HAS-BLED score = 0) |
1.86 (1.45-2.39) | 1.23 (1.03-1.48) | 0.61 (0.51-0.72) | 1.22 (0.98-1.52) | 1.94 (1.61-2.35) | 1.32 (1.15-1.52) | 0.63 (0.54-0.72) | 1.36 (1.17-1.58) |
HAS-BLED score = 2 (vs HAS-BLED score = 0) |
3.66 (2.46-5.43) | 1.36 (1.04-1.78) | 0.76 (0.64-0.90) | 2.28 (1.56-3.32) | 3.98 (2.96-5.36) | 1.70 (1.4-2.07) | 0.81 (0.70-0.93) | 2.39 (1.83-3.11) |
HAS-BLED score ≥3 (vs HAS-BLED score = 0) |
0.99 (0.14-7.05) | 1.01 (0.52-1.97) | – | 3.06 (1.26-7.45) | 4.52 (2.13-9.61) | 1.62 (1.04-2.52) | – | 2.21 (0.99-4.95) |
Contribution to the baseline CHA2DS2-VASc score | ||||||||
Congestive heart failure | – | 1.52 (1.16-1.99) | – | – | – | 1.46 (1.17-1.82) | – | – |
Hypertension | – | 1.02 (0.84-1.24) | – | – | – | 0.97 (0.84-1.13) | – | – |
Diabetes | – | 1.31 (1.01-1.71) | – | – | – | 1.31 (1.07-1.60) | – | – |
Conclusions: More frequent re-evaluation of stroke risk in low-stroke-risk NVAF patients should be considered in male patients with a baseline score of 1 and those with a high baseline HAS-BLED score. Investigations on whether delayed re-evaluation of stroke risk and delayed use of OAC increase risk of ischemic stroke are warranted in future studies.
To cite this abstract in AMA style:
Chen Q, Toorop MM, Cannegieter SC, Lijfering WM. Natural Changes in CHA2DS2-VASc Scores in Newly Diagnosed Non-valvular Atrial Fibrillation Patients with Low Stroke Risk [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/natural-changes-in-cha2ds2-vasc-scores-in-newly-diagnosed-non-valvular-atrial-fibrillation-patients-with-low-stroke-risk/. Accessed March 21, 2024.« Back to ISTH 2021 Congress
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