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Comparison of Clinical Outcomes Among Patients With Atrial Fibrillation or Atrial Flutter Stratified by CHA 2 DS 2 -VASc Score

2018; American Medical Association; Volume: 1; Issue: 4 Linguagem: Inglês

10.1001/jamanetworkopen.2018.0941

2574-3805

Yu‐Sheng Lin, Yung‐Lung Chen, Tien‐Hsing Chen, Ming‐Shyan Lin, Chi‐Hung Liu, Teng‐Yao Yang, Chang-Ming Chung, Mien‐Cheng Chen,

Acute Ischemic Stroke Management

Importance Current guidelines support treating atrial fibrillation (AF) and atrial flutter (AFL) as equivalent risk factors for ischemic stroke stratified by CHA 2 DS 2 -VASc scores, recommending anticoagulation therapy for patients with a CHA 2 DS 2 -VASc score of 2 or higher, but some studies found differences in clinical outcomes. Objective To investigate differences in clinical outcomes among AF, AFL, and matched control cohorts. Design, Setting, and Participants This nationwide cohort study analyzed data from the Taiwan National Health Insurance Research Database from January 1, 2001, through December 31, 2012. Follow-up and data analysis ended December 31, 2012. A total of 219 416 age- and sex-matched individuals participated in the study. Clinical outcomes were compared after stratification by CHA 2 DS 2 -VASc score (possible score range, 0-9; higher scores indicate greater risk of ischemic stroke). Main Outcomes and Measures Ischemic stroke, heart failure hospitalization, and all-cause mortality among the AF, AFL, and matched control cohorts were analyzed using Cox proportional hazards regression. Results This study comprised 188 811 patients in the AF cohort (mean [SD] age, 73.8 [13.4] years; 104 703 [55.5%] male), 6121 patients in the AFL cohort (mean [SD] age, 67.7 [15.8] years; 3735 [61.0%] male), and 24 484 patients in the matched control cohort (mean [SD] age, 67.3 [15.6] years; 14 940 [61.0%] male). The patients with AF were older, were more predominantly female, and had higher CHA 2 DS 2 -VASc scores than the patients with AFL and the control participants. After stratification by CHA 2 DS 2 -VASc score, the incidence densities (IDs; events per 100 person-years) of ischemic stroke (AF cohort: ID, 3.08; 95% CI, 3.03-3.13; AFL cohort: ID, 1.45; 95% CI, 1.28-1.62; controls: ID, 0.97; 95% CI, 0.92-1.03), heart failure hospitalization (AF cohort: ID, 3.39; 95% CI, 3.34-3.44; AFL cohort: ID, 1.57; 95% CI, 1.39-1.74; controls: ID, 0.32; 95% CI, 0.29-0.35), and all-cause mortality (AF cohort: ID, 17.8; 95% CI, 17.7-17.9; AFL cohort: ID, 13.9; 95% CI, 13.4-14.4; controls: ID, 4.2; 95% CI, 4.1-4.4) were significantly higher in the AF cohort than in the matched control cohort. For the AFL cohort vs the matched control cohort, the incidences of heart failure hospitalization and all-cause mortality were significantly higher across all levels, but the incidence of ischemic stroke was only significantly higher at CHA 2 DS 2 -VASc scores of 5 to 9. For the AF cohort vs the AFL cohort, the incidences of ischemic stroke and heart failure hospitalization were significantly higher at a CHA 2 DS 2 -VASc score of 1 or higher, but the incidence of all-cause mortality was significantly higher only at CHA 2 DS 2 -VASc scores of 1 to 3. Conclusions and Relevance This study found different clinical outcomes between patients with AFL and AF and those without AF and AFL. The current recommended level of the CHA 2 DS 2 -VASc score in preventing ischemic stroke in patients with AFL should be reevaluated.