STROKE RISK IN POST-MENOPAUSAL WOMEN WITH ATRIAL FIBRILLATION IN THE WOMEN&apos;S HEALTH INITIATIVE: A VALIDATION AND COMPARISON OF THE CHADS2 AND CHA2DS2-VASC RISK SCORES

Abstract Background Physical activity and macronutrient intake, important contributors to energy balance, may be independently associated with female urinary incontinence (UI). Methods We evaluated the association of baseline self-reported physical activity and macronutrient intake, via food-frequency questionnaire, with incident UI subtypes after 3 years among 19,741 post-menopausal women in the Women’s Health Initiative Observational Study. Odds ratios (OR) for incident urgency, stress, and mixed UI were calculated using multivariable logistic regression. Results Women who reported total physical activity (MET-hours/week) ≥30 vs <0.1 were 16% less likely to develop urgency UI (OR=0.84; 95% CI 0.70, 1.00) and 34% less likely for mixed UI (OR=0.66; 0.46, 0.95), although linear trends were no longer statistically significant after adjusting for baseline weight and weight change (P-trend=0.15 and 0.16, respectively). The association between physical activity and incident stress UI was less consistent. Higher uncalibrated protein intake was associated with increased odds of incident urgency UI (≥19.4% versus <14.1% of energy intake OR=1.14; 95% CI 0.99, 1.30; P-trend=0.02), while confidence intervals were wide and included 1.0 for calibrated protein intake. Other macronutrients were not associated with urgency UI and macronutrient intake was not associated with incident stress or mixed UI (P-trend>0.05 for all). Conclusions Among post-menopausal women, higher physical activity was associated with lower risk of incident urgency and mixed UI, but not stress UI, independent of baseline weight and weight change. Higher protein intake was associated with increase urgency UI, but no associations were observed between other macronutrient and UI subtypes.

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Stroke Risk Scores as Predictors of Severe Outcomes in Atrial Fibrillation

American Journal of Therapeutics ◽

10.1097/mjt.0000000000001357 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Andreea Cristina Ivănescu ◽

Cătălin Adrian Buzea ◽

Caterina Delcea ◽

Gheorghe Andrei Dan

Keyword(s):

Atrial Fibrillation ◽

Stroke Risk ◽

Risk Scores

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Reproductive lifespan and incident stroke risk among post-menopausal women: Is it time for sex-specific risk prediction tools?

International Journal of Cardiology ◽

10.1016/j.ijcard.2020.12.032 ◽

2020 ◽

Author(s):

Islam Y. Elgendy ◽

Hend Mansoor ◽

Carl J. Pepine

Keyword(s):

Risk Prediction ◽

Stroke Risk ◽

Prediction Tools ◽

Specific Risk ◽

Menopausal Women ◽

Post Menopausal

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P094: The frequency of stroke risk assessment tools used to assess patients presenting to the emergency department with atrial fibrillation and flutter

CJEM ◽

10.1017/cem.2016.270 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S109-S110

Author(s):

T. Nikel ◽

S.W. Kirkland ◽

S. Campbell ◽

B.H. Rowe

Keyword(s):

Atrial Fibrillation ◽

Emergency Department ◽

Stroke Risk ◽

Grey Literature ◽

Anticoagulation Therapy ◽

Adult Patients ◽

Assessment Tools ◽

Risk Scores ◽

Atrial Fibrillation And Flutter ◽

Attending Physicians

Introduction: Acute atrial fibrillation or flutter (AFF) is the most common dysrhythmia managed in the emergency department (ED). A key component of managing AFF in the ED is the prevention of stroke. Predictive indices (e.g., CHADS2 , HAS-BLED) should be used to assess each patient’s risk of stroke and bleeding to determine the appropriate anticoagulation therapy. The frequency of use of these predictive indices in the emergency department to determine appropriate anticoagulation therapy remains unclear. This systematic review is designed to examine the use of risk scores in the ED to determine the management of patients presenting to the ED for atrial fibrillation and flutter. Methods: An extensive search of eight electronic databases and grey literature was conducted. Quasi-experimental studies were eligible for inclusion. Studies had to report on the ED management of adult patients presenting with AFF to be included. Two independent reviewers judged the relevance, inclusion, and risk of bias of the studies. Individual and pooled statistics were calculated as odds ratios (OR) with 95% CI using a random effects model and heterogeneity (I2) was reported. Results: From 1,648 citations, 37 studies were included in this review. Heterogeneity was very high, precluding pooling. Only one of the included studies documented the use of CHADS2 scores by attending physicians; while no studies documented the use of HAS-BLED. There was variability in the ED management strategies of AFF. The utilization of rhythm control in the treatment of AFF ranged considerable (OR: 0.04-9.84) in comparison to rate control. Of the 17 studies reporting cardioversion approaches, chemical (9 {53%}) cardioversion was the most common management strategy of AFF. Conclusion: Our results suggests that either few physicians are documenting stroke risk scores in adult patients with AFF, or that research studies assessing ED management of AFF are not reporting scores documented by the attending physicians. Future research needs to examine the use of stroke risk scores to determine the optimal and appropriate care for patients.

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Inhaled medication usage in post-menopausal women and lifetime tobacco smoke exposure: The Women’s Health Initiative Observational Study

Maturitas ◽

10.1016/j.maturitas.2016.05.008 ◽

2016 ◽

Vol 90 ◽

pp. 42-48

Author(s):

Kenneth M. Piazza ◽

Jean Wactawski-Wende ◽

Margaret W. DeBon ◽

Kathleen M. Hovey ◽

Cheryl L. Rivard ◽

...

Keyword(s):

Observational Study ◽

Tobacco Smoke ◽

Smoke Exposure ◽

Tobacco Smoke Exposure ◽

Medication Usage ◽

Health Initiative ◽

Menopausal Women ◽

Post Menopausal ◽

Inhaled Medication ◽

The Women’S Health Initiative

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Abstract 18538: The ATRIA Stroke Risk Score Predicts Ischemic Stroke Better than CHADS2 and CHA2DS2-VASc in a large Swedish Cohort of Patients with Atrial Fibrillation

Circulation ◽

10.1161/circ.130.suppl_2.18538 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Sara Aspberg ◽

Yuchiao Chang ◽

Daniel Singer

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Risk Score ◽

Stroke Risk ◽

Anticoagulation Therapy ◽

Bleeding Risk ◽

Risk Scores ◽

Cut Points ◽

Net Clinical Benefit ◽

Better Than

Introduction: Atrial fibrillation (AF) is a major risk factor for acute ischemic stroke (AIS). Anticoagulation therapy (OAC) effectively prevents AIS, but increases bleeding risk. There is a need for better AIS risk prediction to optimize the anticoagulation decision in AF. The ATRIA stroke risk score (ATRIA) (table) was superior to CHADS2 and CHA2DS2-VASc in two large California community AF cohorts. We now report the performance of the 3 scores in a very large Swedish AF cohort. Methods: The cohort consisted of all Swedish patients hospitalized with a diagnosis of AF from July 1, 2005 to December 31, 2008. Predictor variables and the outcome, AIS, were obtained from inpatient ICD-10 codes. Warfarin use was determined from National Pharmacy Database. Risk scores were assessed via c-index (C) and net reclassification index (NRI). Results: The cohort included 158,370 AF patients off warfarin who contributed 340,332 person-years of follow-up, and 11,823 incident AIS, for an overall AIS rate of 3.47%/yr, higher than the 2%/yr seen in the California cohorts. Using the entire point score, ATRIA had a good C of 0.712 (0.708-0.716), significantly better than CHADS2, 0.694 (0.689-0.698), or CHA2DS2-VASc, 0.697 (0.693-0.702). Using published cut-points for Low/Moderate/High AIS risk, C deteriorated for all scores but ATRIA and CHADS2 were superior to CHA2DS2-VASc. NRI favored ATRIA; 0.16 (0.15-0.18) versus CHADS2; 0.22 (0.21-0.24) versus CHA2DS2-VASc. However, NRI decreased to near-zero when cut-points were altered to better fit the cohort’s stroke rates. Conclusion: Findings in this large Swedish AF cohort validate those in the California AF cohorts, with the ATRIA score predicting stroke risk better than CHADS2 or CHA2DS2-VASc. However, relative performance of the categorical scores varied by population stroke risk. Knowledge about this population risk may be needed to optimize cut-points on the multipoint scores to achieve better net clinical benefit from OAC.

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