Abstract P617: Ischemic Strokes in Patients With Atrial Fibrillation: The Neuro-AFib Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Edip M Gurol ◽  
Alvin S Das ◽  
Nader Daoud ◽  
Alyssa Wohlfahrt ◽  
Elif Gokcal ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Risk ◽  
Clinical Laboratory ◽  
Risk Scores ◽  
Stroke Severity ◽  
Prevention Measures ◽  
Imaging Data ◽  
The Us ◽  
Preventive Methods ◽  
Embolic Risk

Background: An estimated 150,000 atrial fibrillation (AF) patients suffer an ischemic stroke (IS) annually in the US. Understanding the frequency/causes of underuse and failures of current FDA-approved preventive methods in patients with known AF may reduce stroke risk and related death/disability. Methods: The Neuro-AFib study is a multicenter effort geared toward elucidating the causes and consequences of IS and hemorrhagic stroke (HS) in a contemporary AF cohort. The retrospective phase of the study is underway, aiming to obtain detailed clinical, laboratory and multimodal neuro- and cardiac imaging data from ~9,000 AF patients admitted to 30 US academic stroke centers with an IS or HS between 1/2018-12/2019. Clinical data of IS admissions from 12 sites will be discussed. Disability is defined as a modified Rankin Score (mRS) 3-5, outcomes are from the time of hospital discharge. Results: A total of 3944 AF patients presented with an IS, mean age was 76.8 + 12, and 50.2% were female. AF was diagnosed prior to IS in 78% of patients. Data on prestroke antithrombotic usage, embolic risk scores, clinical stroke severity and outcomes are presented in the FIGURE. Conclusions: Preliminary results from the Neuro-AFib study show high rates of underuse of approved stroke prevention measures (54%) and anticoagulant failures (46%) that result into IS even in known AF patients. Relatively high rates of pre-stroke AF detection failures were also noted (22%). Death/disability rates were high in all of these AF-related IS patients ( > 69%). Detailed data collection focused on imaging and lab markers of stroke risk from this contemporary cohort will be ready to be presented during ISC 2021.

Abstract 38: Hemorrhagic Strokes in Patients With Atrial Fibrillation: The Neuro-AFib Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Edip M Gurol ◽  
Alvin S Das ◽  
Nader Daoud ◽  
Alyssa Wohlfahrt ◽  
Elif Gokcal ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Laboratory ◽  
Case Fatality ◽  
Severe Disability ◽  
Superficial Siderosis ◽  
Imaging Data ◽  
Full Cohort ◽  
The Us ◽  
Imaging Markers ◽  
Detailed Imaging

Background: We aimed to compare the clinical features and short-term outcomes of hemorrhagic stroke (HS) to ischemic stroke (IS) in atrial fibrillation (AF) patients using a large contemporary cohort. Methods: The Neuro-AFib study is a multicenter effort to elucidate the current causes and consequences of IS and HS in AF patients. The retrospective phase of the study is underway, aimed at obtaining detailed clinical, laboratory and multimodal neuro- and cardiac imaging data from ~9,000 patients with AF admitted to 30 academic stroke centers in the US with an IS or HS between 1/2018-12/2019. Preliminary clinical data from 12 sites are presented in this abstract. Results: Of 4764 stroke admissions with AF, 820 (17.2%) had HS and 3944 IS. Patients with HS were younger (74.8 + 12 vs 76.8 + 12), more likely to be male (54% vs 46%) and had lower CHA 2 DS 2 -VASC (3.6 + 1.6 vs 3.9 + 1.6) than IS [all p<0.05]. Patients with HS were more likely to be on AC compared to IS (60% vs 38%, p<0.001). Within the HS cohort, 32% were on direct oral anticoagulant, 28% on warfarin, 16% on antiplatelet, and 24% on no antithrombotic. Patients with HS had worse outcomes than IS in terms of in hospital case fatality (32.4 vs 10.3%, p<0.001) and severe disability (modified Rankin Scale 4-5) at discharge (63.3% vs 53.7%, p=0.002) despite similar rates of severe disability before admission (7% vs 6.2%, p=0.73). All of the reported associations remained significant after adjustment for age, sex and other relevant covariates. Conclusions: Preliminary findings from the Neuro-AFib study show significantly worse outcomes for HS compared to IS in AF patients, with triple case fatality and elevated severe disability risks. These results showcase the importance of identifying AF patients at high HS risk. Detailed imaging markers of HS risk including microbleeds, superficial siderosis, leukoaraiosis within the full cohort will be analyzed and discussed during ISC 2021.

Stroke Risk Scores as Predictors of Severe Outcomes in Atrial Fibrillation

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

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.

scholarly journals The ABCD and ABCD2 Scores and the Risk of Stroke following a TIA: A Narrative Review

2011 ◽  
Vol 2011 ◽  
pp. 1-12 ◽  
Author(s):  
Archit Bhatt ◽  
Vishal Jani
Keyword(s):  
Atrial Fibrillation ◽  
Diffusion Weighted Imaging ◽  
Prognostic Value ◽  
Risk Scores ◽  
Large Artery ◽  
Imaging Data ◽  
Short Term ◽  
Vascular Events ◽  
Diffusion Weighted ◽  
Abcd2 Score

The California, ABCD, and ABCD2 risk scores (ABCD system) were developed to help stratify short-term stroke risk in patients with TIA (transient ischemic attack). Beyond this scope, the ABCD system has been extensively used to study other prognostic information such as DWI (diffusion-weighted imaging) abnormalities, large artery stenosis, atrial fibrillation and its diagnostic accuracy in TIA patients, which are independent predictors of subsequent stroke in TIA patients. Our comprehensive paper suggested that all scores have and equivalent prognostic value in predicting short-term risk of stroke; however, the ABCD2 score is being predominantly used at most centers. The majority of studies have shown that more than half of the strokes in the first 90 days, occur in the first 7 days. The majority of patients studied were predominantly classified to have a higher ABCD/ABCD2 > 3 scores and were particularly at a higher short-term risk of stroke or TIA and other vascular events. However, patients with low risk ABCD2 score < 4 may have high-risk prognostic indicators, such as diffusion weighted imaging (DWI) abnormalities, large artery atherosclerosis (LAA), and atrial fibrillation (AF). The prognostic value of these scores improved if used in conjunction with clinical information, vascular imaging data, and brain imaging data. Before more data become available, the diagnostic value of these scores, its applicability in triaging patients, and its use in evaluating long-term prognosis are rather secondary; thus, indicating that the primary significance of these scores is for short-term prognostic purposes.

scholarly journals How Well Do Stroke Risk Scores Predict Hemorrhage in Patients With Atrial Fibrillation?

2016 ◽  
Vol 118 (5) ◽  
pp. 697-699 ◽  
Author(s):  
Gene R. Quinn ◽  
Daniel E. Singer ◽  
Yuchiao Chang ◽  
Alan S. Go ◽  
Leila H. Borowsky ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Risk ◽  
Risk Scores

scholarly journals Predicting Stroke Risk in Patients with Atrial Fibrillation Using Machine Learning

2021 ◽  
Author(s):  
Seonwoo Jung ◽  
Eunjoo Lee ◽  
Minji Lee ◽  
Sejin Bae ◽  
Yeon-Yong Kim ◽  
...  
Keyword(s):  
Machine Learning ◽  
Atrial Fibrillation ◽  
Stroke Risk ◽  
Predictive Performance ◽  
Cerebrovascular Diseases ◽  
Risk Scores ◽  
Health Examination ◽  
History Information ◽  
Korean National Health Insurance ◽  
Deep Learning Model

Abstract Atrial fibrillation (AF) is a well-known risk factor for stroke. Predicting the risk is important to prevent the first attack and re-attack of cerebrovascular diseases by determining the medication. Although several statistical methods have been developed to assess the stroke risk in AF patients, considerable improvement is needed in predictive performance. We propose a machine learning-based approach based on the massive and complex Korean National Health Insurance (KNHIS) data. We extracted 72-dimensional features, including demographics, health examination, and medical history information, of 754,949 patients with AF from KNHIS. Logistic regression was used to determine whether the extracted features had a statistically significant association with stroke occurrence. Then, we constructed the stroke risk prediction model based on a deep neural network. The extracted features were used as input, and the occurrence of stroke after the diagnosis of AF was the output used to train the model. When the proposed deep learning model was applied to 150,989 AF patients, it was confirmed that stroke risk was predicted with high accuracy, sensitivity, and specificity. As part of preventive medicine, this study could help AF patients prepare for stroke prevention based on predicted stoke associated feature and risk scores.

Abstract 18703: Impact of the 2014 Atrial Fibrillation Guideline on the Proportion of Patients Recommended for Oral Anticoagulation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Emily C O’Brien ◽  
Sunghee Kim ◽  
Paul L Hess ◽  
James V Freeman ◽  
Laine Thomas ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulation ◽  
Stroke Risk ◽  
Treatment Guidelines ◽  
Treatment Guideline ◽  
Risk Scores ◽  
Community Based ◽  
Chads2 Score ◽  
Number Of Patients ◽  
Using Data

Introduction: In 2014, the AHA/ACC/HRS published new atrial fibrillation (AF) treatment guidelines recommending use of a refined stroke risk score and revised threshold for oral anticoagulation (OAC) initiation. Methods: Using data from ORBIT-AF, an ongoing, national, outpatient AF registry conducted at 176 sites, we examined changes in the number of patients qualifying for OAC based on clinical stroke risk scores under 2011 ACCF/AHA/HRS versus 2014 AHA/ACC/HRS guidelines. Patients were considered recommended for OAC under the 2011 guideline with a CHADS2 score >=2 and under the 2014 guideline with a CHA2DS2-VASC score >=2. We reported the fraction of patients treated with OAC (warfarin or dabigatran) among patients qualifying for OAC under each guideline. Results: From 2009 - 2010, 10132 patients were enrolled in ORBIT-AF (median age [IQR] = 75 years [67 - 82]; 42.3% female). The proportion of patients qualifying for OAC increased from 71.8% under the 2011 guideline to 90.8% under the 2014 guideline (Figure). For patients under the age of 65, the proportion qualifying for treatment with OAC increased from 43.1% to 60.6%. Similar increases were observed for patients over the age of 65: 79.1% indicated for OAC under the 2011 guideline, compared with 98.5% under the 2014 guideline. There were 97.7% of women who qualified for OAC under the 2014 guideline, compared with 76.7% under the 2011 guideline. The fraction of indicated patients who were not receiving OAC increased under the 2014 guideline (21.9% vs. 19.9% under the 2011 guideline), with the highest undertreatment rates for patients younger than 65 (25.4%). Conclusions: The 2014 AF treatment guideline substantially increased the proportion of patients who qualified for OAC, with near-universal indication for women and for patients older than 65. Under the 2014 guideline, approximately 22% of the indicated patients in our community-based cohort did not receive OAC.

Sign in / Sign up

Export Citation Format

Share Document