The various risk stratification schemes classified variable proportions as low , moderate and high risk , but the CHA(2)DS(2)-VASc score classified the smallest proportion of patients as ' low risk ' .
Anticoagulation with vitamin K antagonists and dabigatran is cost-effective in patients at high risk of stroke , but not in patients without any other stroke risk factor beside AF .
Impact of vascular disease in predicting stroke and death in patients with atrial fibrillation: the Danish Diet, Cancer and Health cohort study.
BACKGROUND The presence of vascular disease ( peripheral artery disease [ PAD ] and /or myocardial infa rct ion [ MI ] ) may impact on the risk of stroke and death among patients with incident atrial fibrillation ( AF ) . To test this hypothesis , we analyzed data from a large Danish prospect i ve cohort , the Danish Diet , Cancer and Health ( DCH ) study , to assess the risk of stroke or death among those who developed AF according to concomitant presence of vascular disease . METHODS A prospect i ve cohort study of 57 , 053 persons ( 27 , 178 men and 29 , 876 women , respectively ) , aged between 50 and 64 years . The risk of stroke or death for patients with vascular disease was assessed amongst 3315 patients with incident AF ( mean age , 67.1years ; 2130 men , 1185 women ) using Cox proportional hazard models , after a median follow-up of 4.8 years . RESULTS Of the subjects with AF , 417 ( 12.6 % ) had ' vascular disease ' ( PAD and /or prior MI ) . The risk of the primary endpoint ( stroke or death ) was significantly higher in patients with vascular disease at 1-year follow-up ( crude hazard ratio [ HR ] 2.51 [ 1.91 - 3.29 ] ) , with corresponding crude HRs for PAD and MI being 3.51 ( 2.40 - 5.13 ) , and 1.99 ( 1.46 - 2.72 ) , respectively . For the secondary endpoints of death or stroke individually , these risk estimates were similar ( crude HR 2.48 [ 1.89 - 3.26 ] and 1.77 [ 1.18 - 2.66 ] , respectively ) . After adjustment for risk factors within the CHADS(2 ) score , the adjusted HR for the primary endpoint ( stroke or death ) in patients with vascular disease was 1.91 ( 1.44 - 2.54 ) , which was also significant for death ( 1.97 [ 1.48 - 2.62 ] ) . CONCLUSION Vascular disease ( prior MI and PAD ) is an independent risk factor for the primary endpoint of ' stroke or death ' in patients with AF , even after adjustment for the CHADS(2 ) risk score , although this is driven by the impact on mortality . This reaffirms that patients with vascular disease represent a ' high-risk ' population , which necessitates proactive management of all cardiovascular risk factors and effective thromboprophylaxis ( i.e. oral anticoagulation ) , which has been shown to significantly reduce the risk of stroke and death in AF
The various risk stratification schemes classified variable proportions as low , moderate and high risk , but the CHA(2)DS(2)-VASc score classified the smallest proportion of patients as ' low risk ' .
Anticoagulation with vitamin K antagonists and dabigatran is cost-effective in patients at high risk of stroke , but not in patients without any other stroke risk factor beside AF .