Abstract 15425: Is Accurate Stroke Risk ssessment with CHADS2 Necessary in Managing Patients with Atrial Fibrillation? Insights from the Stroke Prevention and Rhythm Interventions in Atrial Fibrillation (SPRINT-AF) Registry
Introduction: Guidelines have advocated use of scoring schemes such as CHADS2 to assess stroke risk for patients with atrial fibrillation (AF). However, recent studies had demonstrated poor agreement between physician-reported and scoring-derived stroke risk. From a national registry, we assessed if rates of oral anticoagulant (OAC) use differ between patients whose stroke risks are concordantly or discordantly categorized.
Methods: From December 2012 to July 2013, a cross-sectional analysis of 936 consecutive AF patients was performed, enrolled from 109 primary care and specialty practices in 10 Canadian provinces. Based on clinical judgment, physicians categorized each patient as low, moderate, or high risk for stroke. We categorized patients’ stroke risk based on their CHADS2 score (low: 0; moderate: 1, high: ≥2). Agreement between physician-reported and CHADS2 risk was reported by the weighted kappa. We compared rates of OAC use between patients whose stroke risk was concordantly or discordantly categorized by clinicians, relative to those derived from CHADS2.
Results: Complete data were available in 929 (98.8%) patients for analysis. The weighted kappa between physician-reported and CHADS2-derived stroke risk was 0.41 (95% CI: 0.34 to 0.48). Physician-determined stroke risk was concordantly categorized to CHADS2 scores in 544 (58.6%) patients. Among patients with CHADS2 ≥2, rates of OAC use were similar between the concordant and discordant groups (91.7% vs. 90.4%, p=0.66). For patients with CHADS2=1, rates of OAC use were higher in the concordant group (84.2% vs. 66.4%, p<0.01). For patients with CHADS2=0, rates of OAC use were lower in the concordant group (43.5% vs. 80.0%, p<0.01).
Conclusions: In this contemporary AF registry, the agreement between physician-reported and CHADS2-derived stroke risk was only modest. Despite this, the rate of OAC use in patients at high risk (CHADS2 ≥2) was similarly high between the concordant and discordant groups. However, rates of OAC use between the 2 groups differed among patients at lower stroke risk. Our results suggest that discrepancy in stroke risk categorization is associated with guideline-discordant OAC use, particularly for patients with lower CHADS2 scores.
Author Disclosures: A.C. Ha: Speakers Bureau; Modest; Bayer. Consultant/Advisory Board; Modest; Bayer. N. Singh: Research Grant; Modest; Boehringer-Ingleheim, Bristol-Myers-Squibb, Jaansen Pharma. Honoraria; Modest; Boehringer-Ingleheim, Bristol-Myers-Squibb, Jaansen Pharma, Bayer. J.L. Cox: Research Grant; Significant; Bayer. Honoraria; Modest; Bayer, Boehringer Ingelheim, Bristol-Myers-Squibb, Pfizer. P. Dorian: Honoraria; Modest; Bristol-Meyer-Squibb, Pfizer, Boehringer-Ingleheim, Sanofi. C. Fournier: Honoraria; Modest; Amgen, Astrazeneca, Boeringher Ingelheim, Bristol-Myers-Squibb, Forest Laboratories, Janssen, Merck, Eli-Lilly, Sanofi, GlaxoKlineSmith, Valeant Canada. Consultant/Advisory Board; Modest; Amgen, Astrazeneca, Boeringher Ingelheim, Bristol-Myers-Squibb, Forest Laboratories, Janssen, Merck, Novo Nordisk Canada, Sanofi, Takeda, Valeant Canada. G.J. Mancini: None. A. Shuaib: None. M. Kajil: None. M. Tsigoulis: None. M.K. Gupta: Research Grant; Significant; Bayer. Honoraria; Modest; Bayer, Bristol-Meyer-Squibb, Pfizer.
- © 2014 by American Heart Association, Inc.