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 - 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
SN - 0021-9150
VL - 295
SP - 1
EP - 7
JO - Atherosclerosis
JF - Atherosclerosis
ER -