Does aspirin monotherapy reduce stroke risk in patient with atrial fibrillation and CHA2DS2-VASc score >2 who are not candidates for anticoagulation therapy?

2022 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Ada Hoffman ◽  
Michael M. Braun
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Risk ◽  
Anticoagulation Therapy

Abstract 77: Balancing Risks and Benefits of Anticoagulation Therapy in Atrial Fibrillation in Community Practice: Results from the ORBIT-AF Registry

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Michael W Cullen ◽  
Sunghee Kim ◽  
Jonathan P Piccini ◽  
Alan S Go ◽  
Gregg C Fonarow ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Risk ◽  
Anticoagulation Therapy ◽  
Bleeding Risk ◽  
Community Practice ◽  
Chads2 Score ◽  
Risk Patients ◽  
Study Population ◽  
Risk Treatment ◽  
The Cost

Background Oral anticoagulation (OAC) can reduce stroke risk at the cost of increased bleeding risk in those with atrial fibrillation (AF). Observational data have shown that higher-risk patients with AF most likely to benefit from OAC are less likely to receive OAC at hospital discharge. Methods We used data from ORBIT-AF Registry, a cohort of 9,589 AF patients enrolled among 173 participating outpatient practices. OAC was defined as warfarin or dabigatran use at study enrollment. Stroke and bleeding risk were calculated using the CHADS2 and ATRIA scores, respectively. Results The study population had a mean age of 73.5 years; 57.8% were men. Overall, 76.4% of patients received OAC. Use of OAC rose with increasing CHADS2 stroke risk, from 67% for CHADS2 <1 to 80% for CHADS2 ≥2 (p<0.0001). OAC use fell slightly with increasing ATRIA bleeding risk, from 77% for ATRIA score ≤3 to 74% with ≥5 (p=0.002 for trend). Among patients with low bleeding risk, rates of OAC increased commensurate with stroke risk (p<0.0001 for interaction; see figure). Higher bleeding risk tended to decrease rates of OAC among patients with a CHADS2 score ≥2 (p=0.13 for interaction). Conclusions In community-based outpatients with AF, use of OAC rose with increasing thromboembolic risk and declined with higher bleeding risk. These findings suggest that the risk-treatment paradox may be less that previously reported. Provision of OAC in community practice appears to appropriately consider patients' stroke and bleeding risks. Further research is required to understand how quality improvement initiatives can further improve stroke prevention.

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

CJEM ◽  
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.

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 ◽  
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.

Comparable risk of ischemic stroke in patients with screen-detected atrial fibrillation on single timepoint handheld ECG screening to patients with known AF

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
W Sun ◽  
B Freedman ◽  
C Martinez ◽  
C Wallenhorst ◽  
B.P.Y Yan
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Stroke Risk ◽  
Anticoagulation Therapy ◽  
Clinic Visit ◽  
Initial Screening ◽  
Subdistribution Hazard ◽  
Ischemic Stroke Risk ◽  
Similar Risk

Abstract Aims To determine risk of ischemic stroke in patients with single timepoint screen-detected atrial fibrillation (AF). Methods Cohort of 11,972 consecutive patients aged ≥65 years attending medical outpatient clinics in Hong Kong underwent AF screening using a handheld single-lead ECG (AliveCor) from Dec 2014 to Dec 2017 (NCT02409654). Repeated screening was performed in patients who had &gt;1 clinic visit during the study period. Cohort was divided into 4 exposure groups: (i) new AF detected by initial screening (S1-AF); (ii) new AF detected by subsequent screening or clinically diagnosed during follow up (FU-AF); (iii) known AF and (iv) no initial or subsequent FU-AF (no AF). Exposure in the FU-AF group was handled as a time-dependent variable. All AF exposure groups were further stratified by oral anticoagulant (OAC) use at the end of FU. Cumulative incidence of ischemic stroke was compared between groups during a median FU period of 2.3 (IQR=1.7–3.3) years, using Fine and Gray regression accounting for death as competing risk and using no AF as reference. Results Of 11,972 subjects enrolled, 2,236 (18.7%) had known AF and 9,736 (81.3%) underwent 13,571 screening events during the study period. The yield of newly diagnosed AF on initial screening was 2.3% (n=223/9,736), with 71 new AF detected by subsequent screening. During FU, 2.3% (221/9,442) screen-negative patients were diagnosed with AF clinically. Compared to no AF, S1-AF without OAC had the highest ischemic stroke risk (subdistribution hazard ratio (SHR)=2.79; 1.47–5.27), then FU-AF without OAC (SHR=2.66; 1.21–5.82) and known AF without OAC (SHR=1.97; 1.50–2.57). All AF groups taking OAC had similar risk of ischemic stroke as no AF. Conclusion This is the first study to report the prognosis of AF detected by single timepoint screening. The prognosis is not benign. Both risks of stroke and benefits from anticoagulation therapy were similar between screen-detected and known AF. Funding Acknowledgement Type of funding source: None

Abstract P292: The Economic Burden To Medicare Of Stroke Events In Atrial Fibrillation Populations With And Without Treatment

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Aarti A Patel ◽  
Kristine Ogden ◽  
Mark Veerman ◽  
Samir Mody ◽  
Winnie W Nelson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Economic Burden ◽  
Healthcare Costs ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Anticoagulation Therapy ◽  
Base Case ◽  
Economic Implications ◽  
The Us ◽  
Anticoagulant Prophylaxis

Purpose: About 2.3 million in the US have atrial fibrillation (AF), a diagnosis which confers a 5-fold increased stroke risk. Prevention is paramount as AF-related strokes are often severe. Anticoagulation reduces the annual incidence of stroke in AF patients by 30–40%. However, anticoagulation is prescribed for only about half of appropriate AF patients. More strokes may be prevented with wider use of anticoagulation therapy. This study estimates the economic burden to Medicare of stroke events in AF cohorts, and the estimated economic implications of stroke reduction associated with increased anticoagulant prophylaxis among moderate to high risk stroke patients. Methods: We used a microcosting model to estimate the annual economic burden of ischemic and hemorrhagic strokes in a hypothetical Medicare AF population who were candidates for anticoagulation. The hypothetical AF population of 1,000 included 45% untreated, 10% on antiplatelet and 45% on anticoagulation therapy. AF prevalence, stroke risk (based on CHADS 2 ) and stroke risk-reduction were adjusted for age (≥ 65 yrs), comorbidities and anticoagulation/antiplatelet status. Annual incremental stroke-related healthcare costs were drawn from published literature and adjusted to 2010 US$. Results: The base case model estimated 132 ischemic strokes (21 fatal) and 49 hemorrhagic strokes (19 fatal) generating an estimated $12.25 million in stroke-related healthcare costs to Medicare. Keeping all other variables constant, a 10% increase in anticoagulant use from the untreated population would reduce ischemic stroke events by 12 (to 120; 19 fatal), hemorrhagic stroke events by 4 (to 44; 18 fatal), and stroke-related costs by more than $1 million. Conclusion: A 10% increase in anticoagulant use in a hypothetical AF cohort is expected to reduce stroke events, stroke-related fatalities and stroke-related costs by nearly 9%. Increased use of anticoagulation, with the potential to reduce the incidence of ischemic and hemorrhagic stroke, could significantly decrease stroke events, fatalities, and related healthcare costs.

Assessing absolute stroke risk in patients with atrial fibrillation using a risk factor-based approach

2020 ◽  
Author(s):  
Christina J -Y Lee ◽  
Anne Pernille Toft-Petersen ◽  
Brice Ozenne ◽  
Matthew Phelps ◽  
Jonas Bjerring Olesen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Stroke Risk ◽  
Absolute Risk ◽  
Anticoagulation Therapy ◽  
Individual Risk ◽  
Study Cohort ◽  
Average Risk ◽  
History Of ◽  
The Individual

Abstract Aim To assess the risk of stroke and thromboembolism in patients with atrial fibrillation (AF) based on risk factor combinations of the CHA2DS2-VASc score. Methods and results Using nationwide Danish registries, patients with AF were included from 1997 to 2015 in this retrospective observational study. A multiple logistic regression, including interactions of history of stroke with age at AF, calendar year of AF, and the CHA2DS2-VASc score risk factors (congestive heart failure, hypertension, diabetes, vascular disease, and female sex) were used to predict the personalized risks of stroke within 1 year. A total of 147 842 patients with AF were included in the study cohort (median age 76 years, range 20–100 years, 51% females). Within the first year, 6% of the cohort were diagnosed with stroke. The predicted personalized 1-year absolute risk of stroke varied widely within each CHA2DS2-VASc score. To estimate the personalized risk of stroke an online calculator was created, the Calculator of Absolute Stroke Risk (CARS), which allows calculation of all the possible combinations of the CHA2DS2-VASc score (https://hjerteforeningen.shinyapps.io/riskvisrr/). Conclusion Calculation of the individual risk using a risk factor-based approach as opposed to using average risk for a particular CHA2DS2-VASc score can improve risk estimates. Furthermore, CARS can assist in the communication of the stroke risk for a more evidence-based shared decision-making of whether to initiate oral anticoagulation therapy.

scholarly journals Residual Stroke Risk in Atrial Fibrillation

2021 ◽  
Vol 10 (3) ◽  
pp. 147-153
Author(s):  
Wern Yew Ding
Keyword(s):  
Atrial Fibrillation ◽  
Blood Flow ◽  
Vessel Wall ◽  
Stroke Risk ◽  
Significant Proportion ◽  
Anticoagulation Therapy ◽  
Excess Risk ◽  
Therapeutic Options ◽  
Thromboembolic Complications ◽  
Blood Constituents

AF contributes to increased stroke risk via various mechanisms, including deranged blood constituents, vessel wall abnormalities and abnormal blood flow. This excess risk is frequently managed with anticoagulation therapy, aimed at preventing thromboembolic complications. Yet, a significant proportion of patients with AF remain at high residual stroke risk despite receiving appropriate dose-adjusted anticoagulation. This article explores the residual stroke risk in AF and potential therapeutic options for these patients.

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