title: The CHADS2 and CHA 2DS 2-VASc scores predict new occurrence of atrial fibrillation and ischemic stroke.
abstract: BACKGROUND
  Early identification of individuals who are at risk of developing atrial fibrillation (AF) and ischemic stroke may enable a closer surveillance and thus prompt initiation of oral anticoagulation for stroke prevention.
  
  
  OBJECTIVE
  This study sought to investigate whether congestive heart failure, hypertension, age ≥ 75 years, diabetes, previous stroke (CHADS2) and CHA2DS2-vascular disease, age 65-74 years, sex category (CHA2DS2-VASc) scores can predict new-onset AF and/or ischemic stroke in patients presenting with arrhythmic symptoms.
  
  
  RESULTS
  We prospectively followed up 528 patients (68.5 ± 10.6 years, male 46.2 %) presented for assessment of arrhythmic symptoms but without any documented arrhythmia, including AF for development of new-onset AF and/or ischemic stroke. Their mean CHADS2 and CHA2DS2-VASc scores on presentation were 1.3 ± 1.3 and 2.3 ± 1.5, respectively. After 6.1 years, 89 patients (16.8 %, 2.77 per 100 patient-years) had documented AF, and 65 patients (12.3 %, 2.0 per 100 patient-years) suffered stroke. Both the CHADS2 (C statistic 0.63, 95 % confidence interval (CI) 0.58-0.67, P < 0.0001, optimal cutoff at 1) and CHA2DS2-VASc (C statistic 0.63, 95 % CI 0.59-0.67, P < 0.0001, optimal cutoff at 2) scores provided similar prediction for the new-onset AF. Similarly, CHADS2 (C statistic 0.69, 95 % CI 0.65-0.73, P < 0.0001, optimal cutoff at 2) and CHA2DS2-VASc (C statistic 0.69, 95 % CI 0.65-0.73, P < 0.0001, optimal cutoff at 2) have compatible efficacy for stroke prediction in this Chinese population.
  
  
  CONCLUSIONS
  The CHADS2 and CHA2DS2-VASc scores can be used in patients who presented with arrhythmic symptoms to identify those who are at risk with developing new-onset clinical AF and ischemic stroke for close clinical surveillance and early intervention.
authors: Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China.
authors: Ming-Liang
authors: ML
authors: Zuo
authors: Shasha
authors: S
authors: Liu
authors: Koon-Ho
authors: KH
authors: Chan
authors: Kui-Kai
authors: KK
authors: Lau
authors: Boon-Hor
authors: BH
authors: Chong
authors: Kwok-Fai
authors: KF
authors: Lam
authors: Yap-Hang
authors: YH
authors: Chan
authors: Yuk-Fai
authors: YF
authors: Lau
authors: Gregory Y H
authors: GY
authors: Lip
authors: Chu-Pak
authors: CP
authors: Lau
authors: Hung-Fat
authors: HF
authors: Tse
authors: Chung-Wah
authors: CW
authors: Siu
mesh_terms: D017677:Age Distribution; D000368:Aged; D000465:Algorithms; D001281:Atrial Fibrillation / Q000401:mortality*; D002545:Brain Ischemia / Q000401:mortality*; D015897:Comorbidity; D048909:Diabetes Complications / Q000401:mortality*; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000401:mortality*; D015994:Incidence; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D020521:Stroke; D016019:Survival Analysis; D015996:Survival Rate
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