Reassessment of Risk for Stroke During Follow-up of Patients With Atrial Fibrillation
Authors: Tze-Fan Chao, Chern-En Chiang, Tzeng-Ji Chen, Gregory Y.H. Lip, Shih-Ann Chen
Journal: Annals of Internal Medicine (2018)

Letters7 May 2019Reassessment of Risk for Stroke During Follow-up of Patients With Atrial FibrillationTze-Fan Chao, MD, Chern-En Chiang, MD, Tzeng-Ji Chen, MD, Gregory Y.H. Lip, MD*, and Shih-Ann Chen, MD*Tze-Fan Chao, MDTaipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (T.C., C.C., S.C.)Search for more papers by this author, Chern-En Chiang, MDTaipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (T.C., C.C., S.C.)Search for more papers by this author, Tzeng-Ji Chen, MDTaipei Veterans General Hospital, Taipei, Taiwan (T.C.)Search for more papers by this author, Gregory Y.H. Lip, MD*University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (G.Y.L.)Search for more papers by this author, and Shih-Ann Chen, MD*Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (T.C., C.C., S.C.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-1177 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: International guidelines suggest that oral anticoagulants (OACs) can be omitted for patients with atrial fibrillation (AF) without a CHA2DS2-VASc score greater than 0 (men) or 1 (women) (1, 2). However, stroke risk is not static among patients with AF, and about 90% develop at least 1 new risk factor before presentation with ischemic stroke (3). Therefore, patients with AF who have a CHA2DS2-VASc score of 0 (men) or 1 (women) at baseline and acquire more comorbidities over time would no longer be “low-risk.”Objective: To investigate incidence of an increase in CHA2DS2-VASc score to at least 1 (men) or ...References1. January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC, et al; ACC/AHA Task Force Members. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014;130:e199-267. [PMID: 24682347] doi:10.1161/CIR.0000000000000041 CrossrefMedlineGoogle Scholar2. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al; ESC Scientific Document Group. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37:2893-962. [PMID: 27567408] doi:10.1093/eurheartj/ehw210 CrossrefMedlineGoogle Scholar3. Chao TF, Lip GYH, Liu CJ, Lin YJ, Chang SL, Lo LW, et al. Relationship of aging and incident comorbidities to stroke risk in patients with atrial fibrillation. J Am Coll Cardiol. 2018;71:122-32. [PMID: 29325634] doi:10.1016/j.jacc.2017.10.085 CrossrefMedlineGoogle Scholar4. Cheng CL, Kao YH, Lin SJ, Lee CH, Lai ML. Validation of the National Health Insurance Research Database with ischemic stroke cases in Taiwan. Pharmacoepidemiol Drug Saf. 2011;20:236-42. [PMID: 21351304] doi:10.1002/pds.2087 CrossrefMedlineGoogle Scholar5. Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al; European Heart Rhythm Association. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). J Am Coll Cardiol. 2006;48:854-906. [PMID: 16904574] MedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (T.C., C.C., S.C.)Taipei Veterans General Hospital, Taipei, Taiwan (T.C.)University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (G.Y.L.)Disclaimer: This study is based in part on data from the National Health Insurance Research Database, which is provided by the Bureau of National Health Insurance, Department of Health, and managed by the National Health Research Institutes. The interpretation and conclusions contained herein do not represent those of the Bureau of National Health Insurance, Department of Health, or the National Health Research Institutes.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1177.Reproducible Research Statement:Study protocol, statistical code, and data set: Not available.* Drs. Lip and Chen share senior authorship of this work.This article was published at Annals.org on 1 January 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byStroke risk reassessment and oral anticoagulant initiation in primary care patients with atrial fibrillation: A ten‐year follow‐upGuía ESC 2020 sobre el diagnóstico y tratamiento de la fibrilación auricular, desarrollada en colaboración de la European Association of Cardio-Thoracic Surgery (EACTS)Age threshold for anticoagulation in patients with atrial fibrillation: A Swedish nationwide observational study2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)Stroke and Bleeding Risk Assessment in Atrial Fibrillation: Where Are We Now?Stroke prevention in atrial fibrillation: comparison of recent international guidelinesAnticoagulant Therapy in Initially Low‐Risk Patients With Nonvalvular Atrial Fibrillation Who Develop Risk FactorsPopulation screening for atrial fibrillation by student pharmacists at health fairsRacial and Sex Differences in Stroke Risk in Patients With Atrial FibrillationShould We Judge Stroke Risk by Static or Dynamic Risk Scores? A Focus on the Dynamic Nature of Stroke and Bleeding Risks in Patients With Atrial FibrillationImportance of Risk Reassessment in Patients With Atrial Fibrillation in Guidelines: Assessing Risk as a Dynamic ProcessEvolving paradigms in antithrombotic therapy for anticoagulated patients undergoing coronary stenting 7 May 2019Volume 170, Issue 9Page: 663-664KeywordsAtrial fibrillationDatabasesDisclosureHealth insuranceInternational classification of diseases ninth revision clinical modificationIschemic strokeMedical risk factorsRisk assessmentsStatistical dataStroke ePublished: 1 January 2019 Issue Published: 7 May 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...