CHA2DS2-VASc score and heart rate predict ischemic stroke outcomes in patients with atrial fibrillation

Chih Shan Huang, Chin I. Chen, Ya Ting Liu, Jen Hung Huang, Yi Jen Chen

Research output: Contribution to journalArticle

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Abstract

Purpose: To evaluate the factors determining the severity and outcome of ischemic stroke in patients with atrial fibrillation (AF). Methods: Our study examined 210 patients with AF and acute ischemic stroke to investigate the relative risks of age, gender, comorbidities, CHADS2 and CHA 2DS2-VASc scores, warfarin use, heart rate, and blood pressure on stroke severity, hospitalization duration, and mortality rate. Results: Patients with poor outcomes [n = 109, National Institutes of Health Stroke Scale (NIHSS) scores of ≥8] had elevated CHA2DS2-VASc scores [5, interquartile range (IQR) 3-6 versus 4, IQR 2.5-5, p = 0.005] and were older with a female predominance, less prior warfarin use, and a higher heart rate (93 ± 24 versus 84 ± 20 beats/min, p = 0.004) in the emergency department, with a longer duration of hospitalization (24 ± 23 versus 11 ± 12 days, p <0.001) and a higher mortality rate (11.0% versus 0.0%, p = 0.002) than those with better outcomes (n = 101, low NIHSS scores of ≤ 7). Patients who died (n = 12) were older and had a higher NIHSS, CHADS2 (3.5, IQR 2-4.75 versus 2, IQR 1-4, p = 0.040), or CHA2DS2-VASc (5.5, IQR 4-6 versus 4, IQR 3-5, p = 0.046) scores than patients who survived. The multivariate analysis showed that female gender, no prior warfarin use, and heart rate were independent predictors of stroke severity. Conclusions: Our results showed that CHADS2 and CHA2DS2-VASc scores, and heart rate were useful parameters for predicting outcomes in AF patients with stroke.

Original languageEnglish
Pages (from-to)16-21
Number of pages6
JournalActa Cardiologica Sinica
Volume30
Issue number1
Publication statusPublished - 2014

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Atrial Fibrillation
Heart Rate
Stroke
National Institutes of Health (U.S.)
Warfarin
Hospitalization
Mortality
Hospital Emergency Service
Comorbidity
Multivariate Analysis
Blood Pressure

Keywords

  • Atrial fibrillation
  • Heart rate
  • Ischemic stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

CHA2DS2-VASc score and heart rate predict ischemic stroke outcomes in patients with atrial fibrillation. / Huang, Chih Shan; Chen, Chin I.; Liu, Ya Ting; Huang, Jen Hung; Chen, Yi Jen.

In: Acta Cardiologica Sinica, Vol. 30, No. 1, 2014, p. 16-21.

Research output: Contribution to journalArticle

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abstract = "Purpose: To evaluate the factors determining the severity and outcome of ischemic stroke in patients with atrial fibrillation (AF). Methods: Our study examined 210 patients with AF and acute ischemic stroke to investigate the relative risks of age, gender, comorbidities, CHADS2 and CHA 2DS2-VASc scores, warfarin use, heart rate, and blood pressure on stroke severity, hospitalization duration, and mortality rate. Results: Patients with poor outcomes [n = 109, National Institutes of Health Stroke Scale (NIHSS) scores of ≥8] had elevated CHA2DS2-VASc scores [5, interquartile range (IQR) 3-6 versus 4, IQR 2.5-5, p = 0.005] and were older with a female predominance, less prior warfarin use, and a higher heart rate (93 ± 24 versus 84 ± 20 beats/min, p = 0.004) in the emergency department, with a longer duration of hospitalization (24 ± 23 versus 11 ± 12 days, p <0.001) and a higher mortality rate (11.0{\%} versus 0.0{\%}, p = 0.002) than those with better outcomes (n = 101, low NIHSS scores of ≤ 7). Patients who died (n = 12) were older and had a higher NIHSS, CHADS2 (3.5, IQR 2-4.75 versus 2, IQR 1-4, p = 0.040), or CHA2DS2-VASc (5.5, IQR 4-6 versus 4, IQR 3-5, p = 0.046) scores than patients who survived. The multivariate analysis showed that female gender, no prior warfarin use, and heart rate were independent predictors of stroke severity. Conclusions: Our results showed that CHADS2 and CHA2DS2-VASc scores, and heart rate were useful parameters for predicting outcomes in AF patients with stroke.",
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AB - Purpose: To evaluate the factors determining the severity and outcome of ischemic stroke in patients with atrial fibrillation (AF). Methods: Our study examined 210 patients with AF and acute ischemic stroke to investigate the relative risks of age, gender, comorbidities, CHADS2 and CHA 2DS2-VASc scores, warfarin use, heart rate, and blood pressure on stroke severity, hospitalization duration, and mortality rate. Results: Patients with poor outcomes [n = 109, National Institutes of Health Stroke Scale (NIHSS) scores of ≥8] had elevated CHA2DS2-VASc scores [5, interquartile range (IQR) 3-6 versus 4, IQR 2.5-5, p = 0.005] and were older with a female predominance, less prior warfarin use, and a higher heart rate (93 ± 24 versus 84 ± 20 beats/min, p = 0.004) in the emergency department, with a longer duration of hospitalization (24 ± 23 versus 11 ± 12 days, p <0.001) and a higher mortality rate (11.0% versus 0.0%, p = 0.002) than those with better outcomes (n = 101, low NIHSS scores of ≤ 7). Patients who died (n = 12) were older and had a higher NIHSS, CHADS2 (3.5, IQR 2-4.75 versus 2, IQR 1-4, p = 0.040), or CHA2DS2-VASc (5.5, IQR 4-6 versus 4, IQR 3-5, p = 0.046) scores than patients who survived. The multivariate analysis showed that female gender, no prior warfarin use, and heart rate were independent predictors of stroke severity. Conclusions: Our results showed that CHADS2 and CHA2DS2-VASc scores, and heart rate were useful parameters for predicting outcomes in AF patients with stroke.

KW - Atrial fibrillation

KW - Heart rate

KW - Ischemic stroke

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