http://www.mcmasteroptimalaging.org/full-article/07bd6b405cc395b2de8727fbab083fb7
Lopes RD, Crowley MJ, Shah BR, et al. Stroke Prevention in Atrial Fibrillation
AHRQ Comparative Effectiveness Review. Rockville, MD: Agency for
Healthcare Research and Quality; 2013 Aug. Report No 13-EHC113-EF.
Review question
How effective are tools for predicting stroke and bleeding risk in patients with atrial fibrillation?
Background
Atrial
fibrillation is an abnormal heart rhythm that can cause small clots to
form in the heart. These clots can travel to the brain, causing a
stroke.
Anticoagulant (or blood thinning)
treatment is the therapy of choice for preventing stroke in non-valvular
atrial fibrillation. However, anticoagulants can cause bleeding. People with atrial fibrillation vary a lot in their risk of stroke from AF, and in their risk of bleeding.
Prediction tools assess which people are most likely to benefit from treatment and which are most likely to be harmed.
How the review was done
This summary is based on a systematic review
of 37 studies on predicting stroke risk and 17 studies on predicting
bleeding in people with atrial fibrillation. Average age of participants
ranged from 53 to 81 years. Publication period was 2000 to 2012.
What the researchers found
Scores
from the CHADS2 and CHA2DS2-VASc are best for predicting risk for
stroke. Their average prediction value is 0.70 (ranging from 0.66 to
0.75).
A value of 0.50 means that the tool is
no better than chance in predicting an outcome. A value of 1.0 means
that the tool predicts an event with certainty.
The strength of the evidence for these 2 tools is low.
The HAS-BLED score is best for predicting bleeding risk. Strength of the evidence is moderate.
Conclusions
The CHADS2 and CHA2DS2-VASc scores are best for predicting stroke in people with atrial fibrillation.
HAS-BLED scores are best for predicting bleeding risk.
Tools for predicting stroke or bleeding
|
Tool
|
Description
|
|
CHADS2
|
Congestive heart failure; Hypertension; Age 75 or older; Diabetes; prior Stroke [2 points]
|
|
CHA2DS2-VASC
|
Congestive heart failure; Hypertension; Age 75 or older [2 points]; Diabetes; prior Stroke [2 points]; Vascular disease; Age 65 to 74; Sex = female
|
|
HAS-BLED
|
1
point for each of Hypertension; Abnormal kidney or liver function;
Stroke; Bleeding history or predisposition; Labile international
normalized ratio; Elderly [older than 65]; Drugs/alcohol concomitantly
|
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