Study finds new combined risk score more effectively predicts stroke risk in Afib patients

May 11, 2018, Intermountain Medical Center
Doctors know patients with atrial fibrillation are at a higher risk of having a stroke, and now a new study finds that integrating two separate clinical risk score models more accurately helps clinicians assess the stroke risk of patients with Afib. Credit: Intermountain Medical Center Heart Institute

Doctors know patients with atrial fibrillation are at a higher risk of having a stroke, and now a new study finds that integrating two separate clinical risk score models helps clinicians more accurately assess the stroke risk of patients with Afib.

The composite decision tool studied by researchers from the Intermountain Medical Center Heart Institute in Salt Lake City combines the widely used CHA2DS2-VASc with the Intermountain Risk Scores (IMRS) to derive and validate new stroke prediction scores.

The study shows the new model, IMRS-VASc, was significantly more effective in predicting stroke risk and will give clinicians a more effective and accurate tool to assess patients with cardiovascular disease.

Researchers found that the new IMRS-VASc risk model nearly doubles their ability to appropriately predict compared to the traditional CHA2DS2-VASc risk tool. The development of the IMRS-VASc risk score model is the first step in a research pathway for other conditions that will ultimately result in time and cost savings for both patient and physician.

Researchers will present results from the study at the Heart Rhythm Society's 39th annual Scientific Sessions in Boston on Friday, May 11.

This improved effectiveness of the new risk score model results from better assignment of low-risk and high-risk people to the appropriate stroke prognosis category, said Benjamin Horne, Ph.D., lead author of the study, and director of cardiovascular and genetic epidemiology of the Intermountain Medical Center Heart Institute.

He notes that the CHA2DS2-VASc score places about 80% of women and 50% of men with atrial fibrillation in a group of people at high risk of stroke. In contrast, IMRS-VASc places one third of all people each in a low, moderate, and high-risk category.

Additionally, the study found that IMRS-VASc more appropriately assigns people to the risk group that relates to their actual prognosis, with a lower rate of stroke in the low-risk group (about 1% having a stroke over a two-year period for women and men), and a higher rate in the high-risk category (two-year stroke rates of 6% in women, 5% in men).

This improved effectiveness may help to limit the near-term use of treatments for among people who do not yet need the therapies and reinforce and encourage the use of treatments among those whose short-term risk actually is high, Dr., Horne said.

"We provide information to clinicians so they can make better decisions about who should have oral anticoagulants and who should have other types of medications and diagnostics tests, and which patients need to have more frequent clinic visits," said Dr. Horne. "The result will be care that can be more precisely targeted to each patient's risks and more likely to prevent a stroke."

Dr. Horne said the integrated IMRS-VASc model combines tried-and-true attributes of the CHA2DS2-VASc and the IMRS.

"While the CHA2DS2-VASc is easy to use, it does not reliably predict what will happen in the future. The Intermountain Risk Score incorporates data available to clinicians in the electronic health record to calculate a score that predicts what's going to happen in the future and the two combined result in IMRS-VASc Models," he notes.

The CHA2DS2-VASc score is a mnemonic that's easy and convenient for clinicians to use. Each of the letters and the numbers reflect a characteristic that's used in the score.

  • The C is for CHF, or .
  • The H is for hypertension.
  • The A is for age.
  • D is for diabetes.
  • S is for history of stroke.
  • V is for vascular disease.
  • The second A is for threshold for age.
  • The final S is for sex.
  • The A and S have a 2 by them. Each of these components gets one additional point for each additional risk factor. If you have congestive heart failure you get one point. If you have hypertension you get one. If you're above age 75 you get 2 points, and the S2 means if you have a history of stroke you get 2 points, and subsequently, all the others get 1 point.
  • The second A is for age between 65 to 74, which adds one point.

For the observational study, researchers collected existing data from patients who visited an Intermountain Healthcare clinic from 1990 to 2013. There were 56,000 individuals evaluated in the study to create the score.

Another set of 24,000 patients were then tested after the new combined risk score was created to validate that it worked in a separate set of individuals who hadn't been involved in the creation of the .

The takeaway for patients from the study is more personalized care from clinicians, Dr. Horne said.

"We're working to precisely determine what medications are needed and what tests need to be ordered, so care is tailored to the patient's specific individual needs," he said.

Explore further: Follow-up delta CHA2DS2-VASc score better predicts CVA in A-fib

Related Stories

Follow-up delta CHA2DS2-VASc score better predicts CVA in A-fib

January 9, 2018
(HealthDay)—Assessing change in the CHA2DS2-VASc score over time is more predictive of ischemic stroke in patients with atrial fibrillation (AF) than the baseline score, according to a study published in the Jan. 16 issue ...

Combining risk scores improves decision-making process for AFib patients and physicians

May 11, 2017
Physicians and atrial fibrillation patients must weigh the risks and benefits of using blood thinners to prevent stroke, bleeding, and death—but current guidelines don't do enough to discern a patient's true risk, researchers ...

Combining risk score tools improves stroke prediction for atrial fibrillation patients

March 19, 2017
Combining two independent, scientifically-proven risk measurements allows physicians to better predict an atrial fibrillation patient's risk of stroke or death. The tools also help determine the need for blood thinners in ...

New study finds antithrombotic therapy has no benefit for low-risk atrial fibrillation patients

March 17, 2017
Findings from a large, community-based study show that antithrombotic therapy doesn't decrease low-risk atrial fibrillation patients' risk of suffering a stroke within five years. In fact, researchers found that low-risk ...

CHADS2 risk score assigns over one-third of stroke patients to low or intermediate stroke risk

September 1, 2013
The CHADS2 stroke risk scores 0 or 1 assign more than one-third of patients in atrial fibrillation with stroke to low or intermediate risk not mandating oral anticoagulation, according to research presented at ESC Congress ...

GPs undertreat women with AF

September 1, 2013
General practitioners (GPs) undertreat women with atrial fibrillation (AF), according to research presented at ESC Congress 2013 today by Dr Pierre Sabouret from France. The analysis of more than 15,000 patients showed that ...

Recommended for you

Higher risk of heart attack on Christmas Eve

December 12, 2018
The risk of heart attack peaks at around 10pm on Christmas Eve, particularly for older and sicker people, most likely due to heightened emotional stress, finds a Swedish study in this week's Christmas issue of The BMJ.

Your weight history may predict your heart failure risk

December 12, 2018
In a medical records analysis of information gathered on more than 6,000 people, Johns Hopkins Medicine researchers conclude that simply asking older adult patients about their weight history at ages 20 and 40 could provide ...

Age is the biggest risk for heart disease, but lifestyle and meds have impact

December 12, 2018
Of all the risk factors for heart disease, age is the strongest predictor of potential trouble.

New understanding of mysterious 'hereditary swelling'

December 12, 2018
For the first time ever, biomedical researchers from Aarhus University, Denmark, report cellular defects that lead to a rare disease, hereditary angioedema (HAE), in which patients experience recurrent episodes of swelling ...

Research team traces pathway to cardioprotection in post-ischemic heart failure

December 11, 2018
During an ischemic attack, the heart is temporarily robbed of its blood supply. The aftermath is devastating: reduced heart contractility, heart cell death, and heart failure. Contributing to these detrimental changes is ...

Macrophage cells key to helping heart repair—and potentially regenerate, new study finds

December 11, 2018
Scientists at the Peter Munk Cardiac Centre have identified the type of cell key to helping the heart repair and potentially regenerate following a heart attack.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.