TY - JOUR
T1 - Development of a novel score to predict newly diagnosed atrial fibrillation after ischemic stroke
T2 - The CHASE-LESS score
AU - Hsieh, Cheng Yang
AU - Lee, Cheng Han
AU - Sung, Sheng Feng
N1 - Funding Information:
This research was supported in part by the Ministry of Science and Technology [grant number MOST 107-2314-B-705-001].
Funding Information:
This research was supported in part by the Ministry of Science and Technology [grant number MOST 107-2314-B-705-001 ].
Funding Information:
This study is based in part on data from the National Health Insurance Research Database provided by the National Health Insurance Administration, Ministry of Health and Welfare and managed by National Health Research Institutes. The interpretation and conclusions contained herein do not represent those of National Health Insurance Administration, Ministry of Health and Welfare or National Health Research Institutes. We would like to thank Ms. Li-Ying Sung for English language editing. Appendix A
Publisher Copyright:
© 2020 Elsevier B.V.
PY - 2020/2
Y1 - 2020/2
N2 - Background and aims: Prompt detection of atrial fibrillation (AF) is essential for optimal secondary stroke prevention, but routine long-term cardiac monitoring of all ischemic stroke patients is neither practical nor affordable. We aimed to develop and validate a risk score to identify patients at risk for newly diagnosed AF (NDAF) after ischemic stroke. Methods: Information on adult patients hospitalized for ischemic stroke without known AF was retrieved from a nationwide database. Primary outcome was NDAF within one year following index stroke. A stepwise Cox model was used to screen for predictors. Beta coefficients for the independent predictors were converted to integer points, which were summed to create a risk score. Results: We identified 4 positive predictors and 3 negative predictors. The CHASE-LESS score (Coronary, Heart failure, Age, stroke SEverity, – LipidEmia, Sugar, prior Stroke) comprises coronary artery disease (1 point), congestive heart failure (1 point), age (1 point for every 10 years), stroke severity (National Institutes of Health Stroke Scale; 1 point for 6–13 and 4 points for ≥14), hyperlipidemia (−1 point), diabetes (−1 point), and prior history of stroke or transient ischemic attack (−1 point). Overall, 6.0% (1029/17,076) of patients developed NDAF. The incidence rate ranged from 8/1000 person-years (CHASE-LESS ≤3) to 240/1000 person-years (CHASE-LESS ≥10). The model achieved a c-index of 0.730 in the development cohort and 0.732 in the validation cohort. Conclusions: The CHASE-LESS score could aid clinicians to identify patients at risk of developing NDAF and help prioritize patients for advanced cardiac monitoring.
AB - Background and aims: Prompt detection of atrial fibrillation (AF) is essential for optimal secondary stroke prevention, but routine long-term cardiac monitoring of all ischemic stroke patients is neither practical nor affordable. We aimed to develop and validate a risk score to identify patients at risk for newly diagnosed AF (NDAF) after ischemic stroke. Methods: Information on adult patients hospitalized for ischemic stroke without known AF was retrieved from a nationwide database. Primary outcome was NDAF within one year following index stroke. A stepwise Cox model was used to screen for predictors. Beta coefficients for the independent predictors were converted to integer points, which were summed to create a risk score. Results: We identified 4 positive predictors and 3 negative predictors. The CHASE-LESS score (Coronary, Heart failure, Age, stroke SEverity, – LipidEmia, Sugar, prior Stroke) comprises coronary artery disease (1 point), congestive heart failure (1 point), age (1 point for every 10 years), stroke severity (National Institutes of Health Stroke Scale; 1 point for 6–13 and 4 points for ≥14), hyperlipidemia (−1 point), diabetes (−1 point), and prior history of stroke or transient ischemic attack (−1 point). Overall, 6.0% (1029/17,076) of patients developed NDAF. The incidence rate ranged from 8/1000 person-years (CHASE-LESS ≤3) to 240/1000 person-years (CHASE-LESS ≥10). The model achieved a c-index of 0.730 in the development cohort and 0.732 in the validation cohort. Conclusions: The CHASE-LESS score could aid clinicians to identify patients at risk of developing NDAF and help prioritize patients for advanced cardiac monitoring.
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U2 - 10.1016/j.atherosclerosis.2020.01.003
DO - 10.1016/j.atherosclerosis.2020.01.003
M3 - Article
C2 - 31972497
AN - SCOPUS:85078013182
VL - 295
SP - 1
EP - 7
JO - Atherosclerosis
JF - Atherosclerosis
SN - 0021-9150
ER -
