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Development of a Novel Score to Predict Newly Diagnosed Atrial Fibrillation After Ischemic Stroke: The CHASE-LESS Score

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Development of a Novel Score to Predict Newly Diagnosed Atrial Fibrillation After Ischemic Stroke: The CHASE-LESS Score

Cheng-Yang Hsieh et al. Atherosclerosis.

Abstract

Background and aims: Prompt detection of atrial fibrillation (AF) is essential for optimal secondary stroke prevention, but routine long-term cardiac monitoring of all ischemic stroke patients is neither practical nor affordable. We aimed to develop and validate a risk score to identify patients at risk for newly diagnosed AF (NDAF) after ischemic stroke.

Methods: Information on adult patients hospitalized for ischemic stroke without known AF was retrieved from a nationwide database. Primary outcome was NDAF within one year following index stroke. A stepwise Cox model was used to screen for predictors. Beta coefficients for the independent predictors were converted to integer points, which were summed to create a risk score.

Results: We identified 4 positive predictors and 3 negative predictors. The CHASE-LESS score (Coronary, Heart failure, Age, stroke SEverity, - LipidEmia, Sugar, prior Stroke) comprises coronary artery disease (1 point), congestive heart failure (1 point), age (1 point for every 10 years), stroke severity (National Institutes of Health Stroke Scale; 1 point for 6-13 and 4 points for ≥14), hyperlipidemia (-1 point), diabetes (-1 point), and prior history of stroke or transient ischemic attack (-1 point). Overall, 6.0% (1029/17,076) of patients developed NDAF. The incidence rate ranged from 8/1000 person-years (CHASE-LESS ≤3) to 240/1000 person-years (CHASE-LESS ≥10). The model achieved a c-index of 0.730 in the development cohort and 0.732 in the validation cohort.

Conclusions: The CHASE-LESS score could aid clinicians to identify patients at risk of developing NDAF and help prioritize patients for advanced cardiac monitoring.

Keywords: Atrial fibrillation; Ischemic stroke; Prediction; Risk score.

Conflict of interest statement

Declaration of competing interest The authors declared they do not have anything to disclose regarding conflict of interest with respect to this manuscript.

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