Cited by 4,832Atrial Fibrillation Management and OutcomesAcute Ischemic Stroke ManagementCardiovascular and Diving-Related Complications

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Validation of Clinical Classification Schemes for Predicting Stroke: Results From the National Registry of Atrial Fibrillation

Gage, Brian F., Waterman, Amy D., Shannon, William, Boechler, Michael, Rich, Michael W., Radford, Martha J.·2001·JAMA

DOI 10.1001/jama.285.22.2864

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Abstract

CONTEXT: Patients who have atrial fibrillation (AF) have an increased risk of stroke, but their absolute rate of stroke depends on age and comorbid conditions. OBJECTIVE: To assess the predictive value of classification schemes that estimate stroke risk in patients with AF. DESIGN, SETTING, AND PATIENTS: Two existing classification schemes were combined into a new stroke-risk scheme, the CHADS( 2) index, and all 3 classification schemes were validated. The CHADS( 2) was formed by assigning 1 point each for the presence of congestive heart failure, hypertension, age 75 years or older, and diabetes mellitus and by assigning 2 points for history of stroke or transient ischemic attack. Data from peer review organizations representing 7 states were used to assemble a National Registry of AF (NRAF) consisting of 1733 Medicare beneficiaries aged 65 to 95 years who had nonrheumatic AF and were not prescribed warfarin at hospital discharge. MAIN OUTCOME MEASURE: Hospitalization for ischemic stroke, determined by Medicare claims data. RESULTS: During 2121 patient-years of follow-up, 94 patients were readmitted to the hospital for ischemic stroke (stroke rate, 4.4 per 100 patient-years). As indicated by a c statistic greater than 0.5, the 2 existing classification schemes predicted stroke better than chance: c of 0.68 (95% confidence interval [CI], 0.65-0.71) for the scheme developed by the Atrial Fibrillation Investigators (AFI) and c of 0.74 (95% CI, 0.71-0.76) for the Stroke Prevention in Atrial Fibrillation (SPAF) III scheme. However, with a c statistic of 0.82 (95% CI, 0.80-0.84), the CHADS( 2) index was the most accurate predictor of stroke. The stroke rate per 100 patient-years without antithrombotic therapy increased by a factor of 1.5 (95% CI, 1.3-1.7) for each 1-point increase in the CHADS( 2) score: 1.9 (95% CI, 1.2-3.0) for a score of 0; 2.8 (95% CI, 2.0-3.8) for 1; 4.0 (95% CI, 3.1-5.1) for 2; 5.9 (95% CI, 4.6-7.3) for 3; 8.5 (95% CI, 6.3-11.1) for 4; 12.5 (95% CI, 8.2-17.5) for 5; and 18.2 (95% CI, 10.5-27.4) for 6. CONCLUSION: The 2 existing classification schemes and especially a new stroke risk index, CHADS( 2), can quantify risk of stroke for patients who have AF and may aid in selection of antithrombotic therapy.

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Authors: Gage, B. F., Waterman, A. D., Shannon, W., Boechler, M., Rich, M. W., & Radford, M. J.
Affiliations: Washington University in St. Louis (US)
Houston Methodist (US)
Yale New Haven Hospital (US)
ORCID: Gage, Brian F.
Waterman, Amy D.
Rich, Michael W.
Radford, Martha J.
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2001-06-13
Volume: 285
Issue: 22
Pages: 2864
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.285.22.2864
OpenAlex: W2062786076
Cited by: 4,832
References: 32
Citations by year: 2026: 40 · 2025: 81 · 2024: 106 · 2023: 108 · 2022: 148 · 2021: 180 · 2020: 196 · 2019: 197 · 2018: 253 · 2017: 266 · 2016: 367 · 2015: 400 · 2014: 427 · 2013: 432 · 2012: 409
FWCI: 15.23
Type: journal article
Language: en
Open access: closed
Locations: JAMA (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (500-99-NH01)
Agency for Healthcare Research and Quality (R01 HS10133)
U.S. Public Health Service (500-96-P549, 500-99-VT01, 500-99-ME01, 500-96-P612, 500-99-LA02)
National Cancer Institute (500-99-CA02)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
Keywords: atrial fibrillation, ischemic stroke, stroke risk prediction, Medicare beneficiaries, antithrombotic therapy, warfarin, congestive heart failure, hypertension, diabetes mellitus, transient ischemic attack, model validation
MeSH terms: Aged, Aged, 80 and over, Atrial Fibrillation, Female, Humans, Male, Severity of Illness Index, Cohort Studies, Comorbidity, Proportional Hazards Models, Survival Analysis, Risk Assessment, Stroke

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Validation of Clinical Classification Schemes for Predicting Stroke: Results From the National Registry of Atrial Fibrillation

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