Prognosis in patients with atrial fibrillation and CHA2DS2-VASc Score = 0 in a community-based cohort study.

Patients with atrial fibrillation (AF) and a CHA(2) DS(2) -VASc score = 0 have a very low risk of stroke and current guidelines even recommend no antithrombotic therapy to these patients. We investigated the rate and risk of adverse events and the impact of antithrombotic management in a community based cohort of AF patients with a CHA(2)DS(2)-VASc score = 0. Patients with AF seen in our institution between 2000 and 2010 were identified in a database. The adverse outcomes were investigated during follow-up. Among 8,962 patients with AF, 616 (7%) had a congestive heart failure, hypertension, age ≥75 years (doubled), diabetes, stroke/TIA/thromboembolism (doubled), vascular disease (prior myocardial infarction, peripheral artery disease, or aortic plaque), age 65-74 years, sex category (female) (CHA(2)DS(2)-VASc score) = 0. An oral anticoagulant was prescribed in 273 patients (44%), antiplatelet therapy alone in 145 patients (24%), and no antithrombotic treatment in 198 patients (32%). During a follow up of 876 ± 1,135 days (median 244, interquartile range 1,540 days), 38 patients sustained events (10 stroke/thromboembolism, 19 major bleeding, 17 deaths). Among untreated patients, rates of stroke/thromboembolism, major bleeding and mortality were 0.64%, 1.12%, and 1.08% per year. Prescription of oral anticoagulation and/or antiplatelet therapy was not associated with an improved prognosis for stroke/thromboembolism (relative risk [RR] = 0.99, 95% CI 0.25-3.99, P = 0.99), nor improved survival or net clinical benefit (combination of stroke/thromboembolism, bleeding, and death). In a real life cohort study, AF patients with CHA(2)DS(2) VASc score = 0 had a low risk of stroke/thromboembolism that was not significantly different between those taking oral anticoagulation, antiplatelet therapy, or no antithrombotic therapy. This supports current guideline recommendations for no antithrombotic therapy in these "truly low-risk" patients.

Taillandier S ，Olesen JB ，Clémenty N ，Lagrenade I ，Babuty D ，Lip GY ，Fauchier L ... -  《-》

Reliable identification of "truly low" thromboembolic risk in patients initially diagnosed with "lone" atrial fibrillation: the Belgrade atrial fibrillation study.

Potpara TS ，Polovina MM ，Licina MM ，Marinkovic JM ，Prostran MS ，Lip GY ... -  《-》

The value of the CHA2DS2-VASc score for refining stroke risk stratification in patients with atrial fibrillation with a CHADS2 score 0-1: a nationwide cohort study.

Olesen JB ，Torp-Pedersen C ，Hansen ML ，Lip GY ... -  《-》

Guideline-adherent antithrombotic treatment is associated with improved outcomes compared with undertreatment in high-risk patients with atrial fibrillation. The Euro Heart Survey on Atrial Fibrillation.

Nieuwlaat R ，Olsson SB ，Lip GY ，Camm AJ ，Breithardt G ，Capucci A ，Meeder JG ，Prins MH ，Lévy S ，Crijns HJ ，Euro Heart Survey Investigators ... -  《-》

Predictive value of the CHA2DS2-VASc score in atrial fibrillation patients at high risk for stroke despite oral anticoagulation.

The risk of stroke in atrial fibrillation is heterogeneous and depends upon underlying clinical conditions included in current risk stratification schemes. Recently, the CHA(2)DS(2)-VASc score has been included in guidelines to be more inclusive of common stroke risk factors seen in everyday clinical practice, and useful in defining "truly low risk" subjects. We aimed to assess the usefulness of CHA(2)DS(2)-VASc score to give us an additional prognostic perspective for adverse events and mortality among "real world" anticoagulated patients with atrial fibrillation who are often elderly with many comorbidities. Consecutive outpatients with permanent/paroxysmal nonvalvular atrial fibrillation with CHA(2)DS(2)-VASc≥2 and stabilized oral anticoagulation (international normalized ratio 2.0-3.0) for at least the preceding 6 months were recruited. Patients with CHA(2)DS(2)-VASc≥2 were selected. Adverse cardiovascular events including stroke, acute coronary syndrome, or heart failure; major bleeds; and mortality were recorded during more than 2.5-year-follow-up. Of 933 patients (93.5%) assessed, 432 were males, median age 76 (71-81) years. After a follow-up of 946 (782-1068) days, 109 patients (11.7%) had adverse cardiovascular events, 80 patients (8.6%) had major bleeds, 101 patients (10.8%) died, and 230 (24.6%) had major adverse events (composite end-point). Increasing CHA(2)DS(2)-VASc score by 1 point had a significant impact on the occurrence of cardiovascular events (hazard ratio=1.27; 95% confidence interval, 1.13-1.44; P<.001), mortality (hazard ratio=1.36; 95% confidence interval, 1.19-1.54; P<.001); and major adverse events (hazard ratio=1.23; 95% confidence interval, 1.13-1.34; P<.001). CHA(2)DS(2)-VASc score was not associated with major bleeding episodes. Among high risk atrial fibrillation patients on oral anticoagulation, CHA(2)DS(2)-VASc successfully predicts cardiovascular events and mortality, but not major bleeds.

Jover E ，Roldán V ，Gallego P ，Hernández-Romero D ，Valdés M ，Vicente V ，Lip GY ，Marín F ... -  《-》