Prediction of new-onset atrial fibrillation after first-ever ischemic stroke: A comparison of CHADS2, CHA2DS2-VASc and HATCH scores and the added value of stroke severity

Cheng Yang Hsieh, Cheng Han Lee, Darren Philbert Wu, Sheng Feng Sung

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background and aims: Early detection of atrial fibrillation after stroke is important for secondary prevention in stroke patients without known atrial fibrillation (AF). We aimed to compare the performance of CHADS2, CHA2DS2-VASc and HATCH scores in predicting AF detected after stroke (AFDAS) and to test whether adding stroke severity to the risk scores improves predictive performance. Methods: Adult patients with first ischemic stroke event but without a prior history of AF were retrieved from a nationwide population-based database. We compared C-statistics of CHADS2, CHA2DS2-VASc and HATCH scores for predicting the occurrence of AFDAS during stroke admission (cohort I) and during follow-up after hospital discharge (cohort II). The added value of stroke severity to prediction models was evaluated using C-statistics, net reclassification improvement, and integrated discrimination improvement. Results: Cohort I comprised 13,878 patients and cohort II comprised 12,567 patients. Among them, 806 (5.8%) and 657 (5.2%) were diagnosed with AF, respectively. The CHADS2 score had the lowest C-statistics (0.558 in cohort I and 0.597 in cohort II), whereas the CHA2DS2-VASc score had comparable C-statistics (0.603 and 0.644) to the HATCH score (0.612 and 0.653) in predicting AFDAS. Adding stroke severity to each of the three risk scores significantly increased the model performance. Conclusions: In stroke patients without known AF, all three risk scores predicted AFDAS during admission and follow-up, but with suboptimal discrimination. Adding stroke severity improved their predictive abilities. These risk scores, when combined with stroke severity, may help prioritize patients for continuous cardiac monitoring in daily practice.

Original languageEnglish
Pages (from-to)73-79
Number of pages7
JournalAtherosclerosis
Volume272
DOIs
Publication statusPublished - 2018 May

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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