Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation.

摘要: Background: Contemporary clinical risk stratifi cation schemata for predicting stroke and thromboembolism (TE) in patients with atrial fi brillation (AF) are largely derived from factors identifi ed trial cohorts. Thus, many potential have not been included. Methods: We refi ned the 2006 Birmingham/National Institute Health Clinical Excellence (NICE) schema into a factor-based approach by reclassifying and/or incorporating additional new where relevant. This was then compared existing real-world cohort of AF (n 5 1,084) Euro Heart Survey AF. Results: Risk categorization differed widely between different schemes compared. Patients classified as high ranged 10.2% Framingham to 75.7% Birmingham 2009 schema. The classic CHADS 2 (Congestive heart failure, Hypertension, Age . 75, Diabetes, prior Stroke/transient ischemic attack) categorized largest proportion (61.9%) intermediate-risk strata, whereas classifi 15.1% this category. only 9.2% low risk, scheme 48.3% risk. Calculated C-statistics suggested modest predictive value all TE. fared marginally better (C-statistic, 0.606) than However, those NICE were truly no TE events recorded, occurred 1.4% low-risk subjects. When expressed scoring system, (CHA DS -VASc acronym) showed an increase rate increasing scores ( P trend .003). Conclusion: Our novel, simple schema, based on factor approach, provides some improvement over event rates subjects small could improve our