title: CHA(2)DS(2)-VASc score and prognosis in ischemic strokes with atrial fibrillation.
abstract: The CHA(2)DS(2)-VASc score was developed to improve stroke risk stratification in atrial fibrillation (AF) patients. We sought to analyze the distribution and prognostic value of the CHA(2)DS(2)-VASc score in a cohort of ischemic stroke patients with AF. In total, 439 consecutive stroke patients with AF were studied. The CHA(2)DS(2)-VASc score was calculated according to clinical status before stroke onset. Poor outcome was defined as a modified Rankin score of 3 to 6 at 3 months. Association between CHA(2)DS(2)-VASc score and poor outcome was analyzed using logistic regression analysis. In 95.6% of patients, CHA(2)DS(2)-VASc was >1 and only 41.8% of those with previously diagnosed AF were using oral anticoagulation at the time of the stroke. Poor outcome was found in 53.1% of the patients. In univariate analysis age, female sex, current smoking, previous stroke, CHA(2)DS(2)-VASc score, and stroke severity were associated with outcome. In multivariate analysis, CHA(2)DS(2)-VASc score was independently associated with poor outcome [OR 1.36 (95% CI: 1.14-1.62), P = 0.001] as well as NIHSS [OR 1.22 (95% CI: 1.17-1.26), P < 0.001]. After removing stroke severity, therapeutic anticoagulation was also associated with stroke prognosis [OR 0.45 (95% CI: 0.23-0.86), P = 0.016]. Most patients with ischemic stroke and AF have a high CHA(2)DS(2)-VASc score. Independent of stroke severity, CHA(2)DS(2)-VASc score is associated with 3-month outcome. Despite all the available information and guidelines, our AF patients are clearly undertreated.
authors: Neurology Department, Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autònoma de Barcelona, [corrected] Barcelona, Spain. 96714@parcdesalutmar.cat
authors: Eva
authors: E
authors: Giralt-Steinhauer
authors: Elisa
authors: E
authors: Cuadrado-Godia
authors: Ángel
authors: Á
authors: Ois
authors: Jordi
authors: J
authors: Jiménez-Conde
authors: Ana
authors: A
authors: Rodríguez-Campello
authors: Lluis
authors: L
authors: Planellas
authors: Sara
authors: S
authors: Jimena-García
authors: Miguel Ángel
authors: MÁ
authors: Rubio
authors: Jaume
authors: J
authors: Roquer-González
mesh_terms: D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications; D002545:Brain Ischemia / Q000145:classification* / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D020127:Recovery of Function; D018570:Risk Assessment; D020521:Stroke / Q000145:classification* / Q000150:complications*