Esteve-Pastor M A, Marín F, Bertomeu-Martinez V, Roldán-Rabadán I, Cequier-Fillat Á, Badimon L, Muñiz-García J, Valdés M, Anguita-Sánchez M
Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
Department of Cardiology, Hospital Universitario San Juan, Alicante, Spain.
Intern Med J. 2016 May;46(5):583-9. doi: 10.1111/imj.13048.
Clinical risk scores, CHADS2 and CHA2 DS2 -VASc scores, are the established tools for assessing stroke risk in patients with atrial fibrillation (AF).
The aim of this study is to assess concordance between manual and computer-based calculation of CHADS2 and CHA2 DS2 -VASc scores, as well as to analyse the patient categories using CHADS2 and the potential improvement on stroke risk stratification with CHA2 DS2 -VASc score.
We linked data from Atrial Fibrillation Spanish registry FANTASIIA. Between June 2013 and March 2014, 1318 consecutive outpatients were recruited. We explore the concordance between manual scoring and computer-based calculation. We compare the distribution of embolic risk of patients using both CHADS2 and CHA2 DS2 -VASc scores
The mean age was 73.8 ± 9.4 years, and 758 (57.5%) were male. For CHADS2 score, concordance between manual scoring and computer-based calculation was 92.5%, whereas for CHA2 DS2 -VASc score was 96.4%. In CHADS2 score, 6.37% of patients with AF changed indication on antithrombotic therapy (3.49% of patients with no treatment changed to need antithrombotic treatment and 2.88% of patients otherwise). Using CHA2 DS2 -VASc score, only 0.45% of patients with AF needed to change in the recommendation of antithrombotic therapy.
We have found a strong concordance between manual and computer-based score calculation of both CHADS2 and CHA2 DS2 -VASc risk scores with minimal changes in anticoagulation recommendations. The use of CHA2 DS2 -VASc score significantly improves classification of AF patients at low and intermediate risk of stroke into higher grade of thromboembolic score. Moreover, CHA2 DS2 -VASc score could identify 'truly low risk' patients compared with CHADS2 score.
临床风险评分，即CHADS2和CHA2 DS2-VASc评分，是评估心房颤动（AF）患者中风风险的既定工具。
本研究旨在评估CHADS2和CHA2 DS2-VASc评分的手动计算与基于计算机的计算之间的一致性，并分析使用CHADS2的患者类别以及CHA2 DS2-VASc评分对中风风险分层的潜在改善。
我们链接了来自西班牙心房颤动登记处FANTASIIA的数据。在2013年6月至2014年3月期间，连续招募了1318名门诊患者。我们探讨了手动评分与基于计算机的计算之间的一致性。我们比较了使用CHADS2和CHA2 DS2-VASc评分的患者的栓塞风险分布。
平均年龄为73.8±9.4岁，758名（57.5%）为男性。对于CHADS2评分，手动评分与基于计算机的计算之间的一致性为92.5%，而对于CHA2 DS2-VASc评分为96.4%。在CHADS2评分中，6.37%的AF患者改变了抗血栓治疗的指征（3.49%未接受治疗的患者改为需要抗血栓治疗，2.88%的患者则相反）。使用CHA2 DS2-VASc评分时，只有0.45%的AF患者需要改变抗血栓治疗的建议。
我们发现CHADS2和CHA2 DS2-VASc风险评分的手动计算与基于计算机的评分计算之间具有很强的一致性，抗凝建议的变化很小。使用CHA2 DS2-VASc评分可显著改善对中风低风险和中度风险的AF患者的分类，使其进入更高等级的血栓栓塞评分。此外，与CHADS2评分相比，CHA2 DS2-VASc评分可以识别出“真正低风险”的患者。
