Do physicians correctly calculate thromboembolic risk scores? A comparison of concordance between manual and computer-based calculation of CHADS(2) and CHA(2)DS(2)-VASc scores
Por:
Esteve-Pastor, MA, Marin, F, Bertomeu-Martinez, V, Roldan-Rabadan, I, Cequier-Fillat, A, Badimon, L, Muniz-Garcia, J, Valdes, M, Anguita-Sanchez, M
Publicada:
1 may 2016
Resumen:
Background: Clinical risk scores, CHADS(2) and CHA(2)DS(2)-VASc scores, are the established tools for assessing stroke risk in patients with atrial fibrillation (AF).
Aim: The aim of this study is to assess concordance between manual and computer-based calculation of CHADS(2) and CHA(2)DS(2)-VASc scores, as well as to analyse the patient categories using CHADS(2) and the potential improvement on stroke risk stratification with CHA(2)DS(2)-VASc score.
Methods: 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 CHADS(2) and CHA(2)DS(2)-VASc scores
Results: The mean age was 73.8 +/- 9.4 years, and 758 (57.5%) were male. For CHADS(2) score, concordance between manual scoring and computer-based calculation was 92.5%, whereas for CHA(2)DS(2)-VASc score was 96.4%. In CHADS(2) 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 CHA(2)DS(2)-VASc score, only 0.45% of patients with AF needed to change in the recommendation of antithrombotic therapy.
Conclusion: We have found a strong concordance between manual and computer-based score calculation of both CHADS(2) and CHA(2)DS(2)-VASc risk scores with minimal changes in anticoagulation recommendations. The use of CHA(2)DS(2)-VASc score significantly improves classification of AF patients at low and intermediate risk of stroke into higher grade of thromboembolic score. Moreover, CHA(2)DS(2)-VASc score could identify 'truly low risk' patients compared with CHADS(2) score.
Filiaciones:
Esteve-Pastor, MA:
Hosp Clin Univ Virgen de la Arrixaca, Dept Cardiol, Ctra Madrid Cartagena S-N, Murcia 30120, Spain
Marin, F:
Hosp Clin Univ Virgen de la Arrixaca, Dept Cardiol, Ctra Madrid Cartagena S-N, Murcia 30120, Spain
Bertomeu-Martinez, V:
Hosp Univ San Juan, Dept Cardiol, Alicante, Spain
Roldan-Rabadan, I:
Hosp La Paz, Dept Cardiol, Madrid, Spain
Cequier-Fillat, A:
Bellvitge Hosp, Dept Cardiol, Barcelona, Spain
Badimon, L:
Hosp Santa Creu & Sant Pau, IIB St Pau, CSIC ICCC, Cardiovasc Res Ctr, Barcelona, Spain
Muniz-Garcia, J:
Hosp Univ A Coruna, Dept Cardiol, La Coruna, Spain
Valdes, M:
Hosp Clin Univ Virgen de la Arrixaca, Dept Cardiol, Ctra Madrid Cartagena S-N, Murcia 30120, Spain
Anguita-Sanchez, M:
Hosp Univ Reina Sofia, Dept Cardiol, Cordoba, Spain
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