Stroke Risk-Stratification Scores Have Limited Prognostic Value in Elders with AF – General Medicine

3 Aug

Stroke Risk-Stratification Scores Have Limited Prognostic Value in Elders with AF

The authors suggest anticoagulation for all elders with atrial fibrillation.

Several stroke risk-stratification scores are available to determine which patients with atrial fibrillation (AF) will benefit from long-term warfarin anticoagulation. However, these scores were based on populations in which elders — the group most likely to have AF — were underrepresented. In this study, U.K. investigators compared the predictive power of eight stroke risk-stratification scores (CHADS2 original, CHADS2 revised, Framingham, NICE, ACC/AHA/ESC, ACCP, CHA2DS2-VASchttp://general-medicine.jwatch.org/articles/JO2011030301.jpg, and Rietbrock modified CHADS2) among 665 participants (age, 75; mean age, 81; 55% men) with AF who did not take warfarin throughout or for part of the Birmingham Atrial Fibrillation Treatment of the Aged (BAFTA) trial.

After median follow-up of 2.2 years, 54 participants (8.0%) experienced ischemic stroke, 13 (2.0%) had transient ischemic attacks, and 4 (0.6%) suffered systemic embolism. All scores performed poorly (C-statistic range, 0.55–0.62, indicating that prediction of stroke for any given person wasn’t much better than chance).

Comment: In this study, various stroke risk-stratification scores had limited ability to predict ischemic stroke in elders with AF. The authors conclude that “until better scores are available,” clinicians should consider all older patients (age, 75) with AF to be at high risk for stroke and should offer long-term anticoagulation to those who are appropriate candidates for this treatment (rather than prescribing aspirin, which is less effective in preventing stroke and is associated with an incidence of major bleeding events that is similar to warfarin’s in this population).

— Paul S. Mueller, MD, MPH, FACP

Published in Journal Watch General Medicine August 2, 2011

via Stroke Risk-Stratification Scores Have Limited Prognostic Value in Elders with AF – General Medicine.

2 Responses to “Stroke Risk-Stratification Scores Have Limited Prognostic Value in Elders with AF – General Medicine”

  1. maturinuk August 3, 2011 at 09:07 #

    Timely article. A couple of my patients are struggling with warfarin dosing and there is pressure to stop this. Have felt the risk of stroke outweighs the dangers of warfarin use and this article supports my stance.

Trackbacks/Pingbacks

  1. New Anti-Coagulants are Good BUT Caution Needed With Dabigatran in the Elderly « Earl's View - August 4, 2011

    […] Stroke Risk-Stratification Scores Have Limited Prognostic Value in Elders with AF – General Me… (maturinuk.wordpress.com) […]

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