CHA2DS2-VASc Score and Heart Rate Predict Ischemic Stroke Outcomes in Patients withAtrial Fibrillation.
OBJECTIVE
To evaluate the factors determining the severity and outcome of ischemic stroke in patients with atrial fibrillation (AF).


METHODS
Our study examined 210 patients with AF and acute ischemic stroke to investigate the relative risks of age, gender, comorbidities, CHADS2 and CHA2DS2-VASc scores, warfarin use, heart rate, and blood pressure on stroke severity, hospitalization duration, and mortality rate.


RESULTS
Patients with poor outcomes [n = 109, National Institutes of Health Stroke Scale (NIHSS) scores of ≥ 8] had elevated CHA2DS2-VASc scores [5, interquartile range (IQR) 3-6 versus 4, IQR 2.5-5, p = 0.005] and were older with a female predominance, less prior warfarin use, and a higher heart rate (93 ± 24 versus 84 ± 20 beats/min, p = 0.004) in the emergency department, with a longer duration of hospitalization (24 ± 23 versus 11 ± 12 days, p < 0.001) and a higher mortality rate (11.0% versus 0.0%, p = 0.002) than those with better outcomes (n = 101, low NIHSS scores of ≤ 7). Patients who died (n = 12) were older and had a higher NIHSS, CHADS2 (3.5, IQR 2-4.75 versus 2, IQR 1-4, p = 0.040), or CHA2DS2-VASc (5.5, IQR 4-6 versus 4, IQR 3-5, p = 0.046) scores than patients who survived. The multivariate analysis showed that female gender, no prior warfarin use, and heart rate were independent predictors of stroke severity.


CONCLUSIONS
Our results showed that CHADS2 and CHA2DS2-VASc scores, and heart rate were useful parameters for predicting outcomes in AF patients with stroke.


BACKGROUND
Atrial fibrillation; CHA2DS2-VASc score; Heart rate; Ischemic stroke.
Department of Neurology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan;
Chih-Shan
CS
Huang
Department of Neurology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan;
Chin-I
CI
Chen
Department of Neurology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan;
Ya-Ting
YT
Liu
Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan;
Jen-Hung
JH
Huang
Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; ; Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan.
Yi-Jen
YJ
Chen