Abstract 14923: Comparative Performance of ATRIA, CHADS2, R2CHADS2 and CHA2DS2-VASc Risk Scores Predicting Stroke in Patients With Atrial Fibrillation: A Nationwide Cohort sSudy in Korea
Background: Recently, the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) score, was developed and validated for stroke risk stratification for atrial fibrillation (AF). This study compared predictive ability of the ATRIA, CHA2DS2-VASc, CHADS2, and R2CHADS2 scores and their implications for anticoagulant treatment in patients with non-valvular AF.
Methods: Patients with non-valvular AF not using oral anticoagulants (OACs) were included from 506,806 adults in prospective cohort data collected by the National Health Insurance Service in Korea. Patients were followed from AF diagnosis until occurrence of ischemic stroke, prescription of OAC, death, or the study’s end. Independent predictors of ischemic stroke were identified and the c-index and net reclassification improvement were calculated.
Results: During 14,430 person-years of follow-up, we observed 188 ischemic strokes. Annualized stroke rate was 1.3%. The C statistics for the full-range ATRIA score was 0.77 (95% confidence interval [CI]: 0.74 to 0.80), significantly better than the CHA2DS2-VASc of 0.74 (95% CI: 0.70 to 0.77), the CHADS2 of 0.74 (95% CI: 0.71 to 0.78), and the R2CHADS2 of 0.74 (95% CI: 0.70 to 0.78). The ATRIA score also improved the net reclassification index by 34% compared with CHA2DS2-VASc score, 17% compared with CHADS2 score, and 6.9% compared with R2CHADS2 score. Among 2,390 patients categorized as low-risk on the basis of an ATRIA score of 0 to 5, the patients were categorized as low, moderate, and high-risk on the basis of CHA2DS2-VASc score, and annual stroke rates ranged from 0.13% to 0.56%.
Conclusions: The ATRIA score performed better in the Korean national cohort. It more accurately identified low-risk patients than the CHA2DS2-VASc score, which assigned these patients to higher-risk categories. Such reclassification of stroke risk could prevent overuse of anticoagulants in very low stroke risk patients with AF.
Author Disclosures: D. Kim: None. P. Yang: None. T. Kim: None. J. Uhm: None. H. Pak: None. M. Lee: None. B. Joung: None.
- © 2016 by American Heart Association, Inc.