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Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn. A Systematic Review of the CHADS 2 Score for Predicting Stroke Risk in Patients with Non-rheumatic Atrial Fibrillation Claire Keogh, Emma Wallace, Ciara Dillon, Borislav Dimitrov, Tom Fahey . Aim.

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Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

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  1. Royal College of Surgeons in IrelandColáiste Ríoga na Máinleá in Éirinn A Systematic Review of the CHADS2 Score for Predicting Stroke Risk in Patients with Non-rheumatic Atrial Fibrillation Claire Keogh, Emma Wallace, Ciara Dillon, Borislav Dimitrov, Tom Fahey

  2. Aim • Assess the performance of the CHADS2 score at predicting thrombotic stroke in patients with non-rheumatic atrial fibrillation (NRAF)

  3. Background • Non-rheumatic atrial fibrillation (NRAF) is the most common cardiac arrhythmia • Population prevalence of 0.5 – 1% • NRAF is associated with a fivefold increased risk of thrombotic stroke • A number of CPRs have been developed for predicting stroke for this population

  4. CHADS2 Score • (i) Congestive heart failure (1 point) • (ii) Hypertension (1 point) • (iii)Age >75 (1 point) • (iv) Diabetes mellitus (1 point) • (v)/(vi) History of Stroke /TIA (2 points) CHADS2 Score0 CHADS2 Score1 to 2 CHADS2 Score3 to 6 Low risk: 1.6% Moderate risk: 4.0% High risk: 8.3% Anti-thrombotictreatment No treatment Anti-platelettreatment

  5. Statistical Methods • Derived study used as predictive model • Results presented as a ratio measurement: predicted strokes by CHADS2 score observed strokes in validation study • Risk adjusted for the impact of warfarin

  6. Results

  7. CHADS2 Score • (i) Congestive heart failure (1 point) • (ii) Hypertension (1 point) • (iii)Age >75 (1 point) • (iv) Diabetes mellitus (1 point) • (v)/(vi) History of Stroke /TIA (2 points) CHADS2 Score0 CHADS2 Score1 to 2 CHADS2 Score3 to 6 Low risk: 1.6% Moderate risk: 4.0% High risk: 8.3% Anti-thrombotictreatment No treatment Anti-platelettreatment

  8. CHADS2 Score 0: Low RiskRisk adjusted for warfarin n = 479 Events = 2 (0.4%)

  9. CHADS2 Score • (i) Congestive heart failure (1 point) • (ii) Hypertension (1 point) • (iii)Age >75 (1 point) • (iv) Diabetes mellitus (1 point) • (v)/(vi) History of Stroke /TIA (2 points) CHADS2 Score0 CHADS2 Score1 to 2 CHADS2 Score3 to 6 Low risk: 1.6% Moderate risk: 4.0% High risk: 8.3% Anti-thrombotictreatment No treatment Anti-platelettreatment

  10. CHADS2 Score 1-2: Medium Risk Risk adjusted for warfarin n = 12 440 Events = 137 (1.1%)

  11. CHADS2 Score • (i) Congestive heart failure (1 point) • (ii) Hypertension (1 point) • (iii)Age >75 (1 point) • (iv) Diabetes mellitus (1 point) • (v)/(vi) History of Stroke /TIA (2 points) CHADS2 Score0 CHADS2 Score1 to 2 CHADS2 Score3 to 6 Low risk: 1.6% Moderate risk: 4.0% High risk: 8.3% Anti-thrombotictreatment No treatment Anti-platelettreatment

  12. CHADS2 Score 3-6: High Risk Risk adjusted for warfarin n = 4248 Events = 138 (3.2%)

  13. Summary and Discussion • The study is limited by the need to adjust for the effect of warfarin treatment, the small number of studies and patients • Awaiting further clarification from a number of authors • This work validates the three risk strata of the CHADS2 score (low, medium and high risk) suggesting that the score can be used to determine treatment choice for patients with NRAF

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