Abstract 17629: A Novel Specific Risk Stratification Score Improves Stroke Prediction in Dialysis Patients with Atrial Fibrillation
Introduction: In dialysis (ESRD) patients with atrial fibrillation (AF), we have previously shown that CHADS2 and CHA2DS2VASc (CHF, Hypertension (HTN), Age, Diabetes, Stroke (CVA), Vascular disease) score predicted risk of CVA. However, multivariate analysis showed that CHF, HTN, and PVD individually were not predictive. We theorized that a risk stratification scoring scheme tailored to unique ESRD co-morbidities may improve CVA prediction in this population.
Methods: All incident adult ESRD cases from the US Renal Data System (2005-2008), were queried for CVA, AF or flutter and selected conditions using ICD-9 diagnosis codes and CMS form 2728. Logistic regression was used to estimate the odds ratio (OR) of individual co-morbidities for CVA. The area under the receiver operator curves (AROC) for CHADS2 and CHA2DS2VASc scores were compared to the ARCHSS2 (Age, Race, Cause of ESRD is HTN, Sex (female) and previous Stroke) score.
Results: Of 443,890 incident ESRD patients, 35,147 had a diagnosis of AF or flutter. Of these patients, 83% were white, 14% black, 42% female and mean age of 75.4 years. Significant risk factors for CVA & point value () included Sex (1), ESRD from HTN in non-black patients(1), Previous CVA(2) and Age Range (1-2). When compared to CHADS2 and CHA2DS2VASc, ARCHSS2 improved CVA predictability (table).
Conclusions: ARCHSS2 scoring predicts risk for stroke in ESRD patients with AF or flutter. When compared to CHADS2 and CHA2DS2VASc scoring, ARCHSS2 improves CVA prediction. The ARCHSS2 score applied to ESRD patients with AF may help guide clinicians in the need for anticoagulation prophylaxis for CVA prevention.
Author Disclosures: W. Maddox: Consultant/Advisory Board; Modest; Boston Scientific Corporation. J. Waller: None. A. Guha: None. M. Diamond: None. M. Murphy: None. S. Litwin: None. S. Nahman: None. M. Kheda: None. R.A. Sorrentino: None.
- © 2014 by American Heart Association, Inc.