Development of a novel score to predict newly diagnosed atrial fibrillation after ischemic stroke: The CHASE-LESS score.
Atherosclerosis. 2020 Jan 13;295:1-7
Authors: Hsieh CY, Lee CH, Sung SF
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.
PMID: 31972497 [PubMed – as supplied by publisher]