Contemporary management of atrial fibrillation and the predicted vs. absolute risk of ischaemic stroke despite treatment: a report from ESC-EHRA EORP-AF Long-Term General Registry

Wern Yew Ding; Carina Blomström-Lundqvist; Laurent Fauchier; Francisco Marin; Tatjana S. Potpara; Giuseppe Boriani; Gregory Y. H. Lip; ESC-EHRA EORP-AF Long-Term General Registry Investigators; A. Marni Joensen; A. Gammelmark; L. Hvilsted Rasmussen; P. Dinesen; S. Riahi; S. Krogh Venø; B. Sorensen; A. Korsgaard; K. Andersen; C. Fragtrup Hellum

doi:10.1093/europace/euac214

Contemporary management of atrial fibrillation and the predicted vs. absolute risk of ischaemic stroke despite treatment: a report from ESC-EHRA EORP-AF Long-Term General Registry

Wern Yew Ding, Carina Blomström-Lundqvist, Laurent Fauchier, Francisco Marin, Tatjana S. Potpara, Giuseppe Boriani, Gregory Y. H. Lip^*, ESC-EHRA EORP-AF Long-Term General Registry Investigators, A. Marni Joensen (Member of study group), A. Gammelmark (Member of study group), L. Hvilsted Rasmussen (Member of study group), P. Dinesen (Member of study group), S. Riahi (Member of study group), S. Krogh Venø (Member of study group), B. Sorensen (Member of study group), A. Korsgaard (Member of study group), K. Andersen (Member of study group), C. Fragtrup Hellum (Member of study group)

^*Corresponding author for this work

Research output: Contribution to journal › Journal article › Research › peer-review

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Abstract

BACKGROUND: Risk stratification in patients with atrial fibrillation (AF) is important to facilitate guideline-directed therapies. The Calculator of Absolute Stroke Risk (CARS) scheme enables an individualized estimation of 1-year absolute risk of stroke in AF. We aimed to investigate the predicted and absolute risks of ischaemic stroke, and evaluate whether CARS (and CHA2DS2-VASc score) may be useful for identifying high risk patients with AF despite contemporary treatment.

METHODS: We utilized the EORP-AF General Long-Term Registry which prospectively enrolled patients with AF from 250 centres across 27 participating European countries. Patients with sufficient data to determine CARS and CHA2DS2-VASc score, and reported outcomes of ischaemic stroke were included in this analysis. The primary outcome of ischaemic stroke was recorded over a 2-year follow-up period.

RESULTS: A total of 9444 patients were included (mean age 69.1 [±11.4] years; 3776 [40.0%] females). There was a high uptake (87.9%) of anticoagulation therapy, predominantly with vitamin K antagonist (50.0%). Over a mean follow-up period of 24 months, there were a total of 101 (1.1%) ischaemic stroke events. In the entire cohort, the median CARS and absolute annual risks of ischaemic stroke were 2.60 (IQR 1.60-4.00) and 0.53% (95%CI 0.43-0.64%), respectively. There was no statistical difference between the predictive performance of CARS and CHA2DS2-VASc score (0.621 [95%CI 0.563-0.678] vs. 0.626 [95%CI 0.573-0.680], P = 0.725).

CONCLUSION: Contemporary management of AF was associated with a low risk of ischaemic stroke. CARS and CHA2DS2-VASc score may be useful to identify high risk patients despite treatment who may benefit from more aggressive treatment and follow-up.

Original language	English
Article number	euac214
Journal	Europace
Volume	25
Issue number	2
Pages (from-to)	277-282
Number of pages	6
ISSN	1099-5129
DOIs	https://doi.org/10.1093/europace/euac214
Publication status	Published - 16 Feb 2023

Bibliographical note

Keywords

Absolute stroke risk
Aged
Anticoagulants/therapeutic use
Atrial Fibrillation/complications
Atrial fibrillation
Brain Ischemia/diagnosis
CARS
CHA2DS2-VASc score
EORP-AF
Female
Humans
Ischaemic stroke
Ischemic Stroke
Male
Predictive stroke risk
Registries
Risk Assessment
Risk Factors
Stroke/diagnosis
CHA DS -VASc score

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Ding, W. Y., Blomström-Lundqvist, C., Fauchier, L., Marin, F., Potpara, T. S., Boriani, G., Lip, G. Y. H., ESC-EHRA EORP-AF Long-Term General Registry Investigators, Joensen, A. M., Gammelmark, A., Rasmussen, L. H., Dinesen, P., Riahi, S., Venø, S. K., Sorensen, B., Korsgaard, A., Andersen , K., & Hellum, C. F. (2023). Contemporary management of atrial fibrillation and the predicted vs. absolute risk of ischaemic stroke despite treatment: a report from ESC-EHRA EORP-AF Long-Term General Registry. Europace, 25(2), 277-282. Article euac214. https://doi.org/10.1093/europace/euac214

@article{b8b2f8668cc64b29a48efd9450a3d869,

title = "Contemporary management of atrial fibrillation and the predicted vs. absolute risk of ischaemic stroke despite treatment: a report from ESC-EHRA EORP-AF Long-Term General Registry",

abstract = "BACKGROUND: Risk stratification in patients with atrial fibrillation (AF) is important to facilitate guideline-directed therapies. The Calculator of Absolute Stroke Risk (CARS) scheme enables an individualized estimation of 1-year absolute risk of stroke in AF. We aimed to investigate the predicted and absolute risks of ischaemic stroke, and evaluate whether CARS (and CHA2DS2-VASc score) may be useful for identifying high risk patients with AF despite contemporary treatment.METHODS: We utilized the EORP-AF General Long-Term Registry which prospectively enrolled patients with AF from 250 centres across 27 participating European countries. Patients with sufficient data to determine CARS and CHA2DS2-VASc score, and reported outcomes of ischaemic stroke were included in this analysis. The primary outcome of ischaemic stroke was recorded over a 2-year follow-up period.RESULTS: A total of 9444 patients were included (mean age 69.1 [±11.4] years; 3776 [40.0%] females). There was a high uptake (87.9%) of anticoagulation therapy, predominantly with vitamin K antagonist (50.0%). Over a mean follow-up period of 24 months, there were a total of 101 (1.1%) ischaemic stroke events. In the entire cohort, the median CARS and absolute annual risks of ischaemic stroke were 2.60 (IQR 1.60-4.00) and 0.53% (95%CI 0.43-0.64%), respectively. There was no statistical difference between the predictive performance of CARS and CHA2DS2-VASc score (0.621 [95%CI 0.563-0.678] vs. 0.626 [95%CI 0.573-0.680], P = 0.725).CONCLUSION: Contemporary management of AF was associated with a low risk of ischaemic stroke. CARS and CHA2DS2-VASc score may be useful to identify high risk patients despite treatment who may benefit from more aggressive treatment and follow-up.",

keywords = "Absolute stroke risk, Aged, Anticoagulants/therapeutic use, Atrial Fibrillation/complications, Atrial fibrillation, Brain Ischemia/diagnosis, CARS, CHA2DS2-VASc score, EORP-AF, Female, Humans, Ischaemic stroke, Ischemic Stroke, Male, Predictive stroke risk, Registries, Risk Assessment, Risk Factors, Stroke/diagnosis, CHA DS -VASc score",

author = "Ding, {Wern Yew} and Carina Blomstr{\"o}m-Lundqvist and Laurent Fauchier and Francisco Marin and Potpara, {Tatjana S.} and Giuseppe Boriani and Lip, {Gregory Y. H.} and {ESC-EHRA EORP-AF Long-Term General Registry Investigators} and Joensen, {A. Marni} and A. Gammelmark and Rasmussen, {L. Hvilsted} and P. Dinesen and S. Riahi and Ven{\o}, {S. Krogh} and B. Sorensen and A. Korsgaard and K. Andersen and Hellum, {C. Fragtrup}",

note = "{\textcopyright} The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.",

year = "2023",

month = feb,

day = "16",

doi = "10.1093/europace/euac214",

language = "English",

volume = "25",

pages = "277--282",

journal = "Europace",

issn = "1099-5129",

publisher = "Oxford University Press",

number = "2",

}

Ding, WY, Blomström-Lundqvist, C, Fauchier, L, Marin, F, Potpara, TS, Boriani, G, Lip, GYH, ESC-EHRA EORP-AF Long-Term General Registry Investigators, Joensen, AM , Gammelmark, A , Rasmussen, LH , Dinesen, P , Riahi, S , Venø, SK, Sorensen, B, Korsgaard, A, Andersen , K & Hellum, CF 2023, 'Contemporary management of atrial fibrillation and the predicted vs. absolute risk of ischaemic stroke despite treatment: a report from ESC-EHRA EORP-AF Long-Term General Registry', Europace, vol. 25, no. 2, euac214, pp. 277-282. https://doi.org/10.1093/europace/euac214

Contemporary management of atrial fibrillation and the predicted vs. absolute risk of ischaemic stroke despite treatment: a report from ESC-EHRA EORP-AF Long-Term General Registry. / Ding, Wern Yew; Blomström-Lundqvist, Carina; Fauchier, Laurent et al.
In: Europace, Vol. 25, No. 2, euac214, 16.02.2023, p. 277-282.

Research output: Contribution to journal › Journal article › Research › peer-review

TY - JOUR

T1 - Contemporary management of atrial fibrillation and the predicted vs. absolute risk of ischaemic stroke despite treatment

T2 - a report from ESC-EHRA EORP-AF Long-Term General Registry

AU - Ding, Wern Yew

AU - Blomström-Lundqvist, Carina

AU - Fauchier, Laurent

AU - Marin, Francisco

AU - Potpara, Tatjana S.

AU - Boriani, Giuseppe

AU - Lip, Gregory Y. H.

AU - ESC-EHRA EORP-AF Long-Term General Registry Investigators

A2 - Joensen, A. Marni

A2 - Gammelmark, A.

A2 - Rasmussen, L. Hvilsted

A2 - Dinesen, P.

A2 - Riahi, S.

A2 - Venø, S. Krogh

A2 - Sorensen, B.

A2 - Korsgaard, A.

A2 - Andersen , K.

A2 - Hellum, C. Fragtrup

N1 - © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.

PY - 2023/2/16

Y1 - 2023/2/16

N2 - BACKGROUND: Risk stratification in patients with atrial fibrillation (AF) is important to facilitate guideline-directed therapies. The Calculator of Absolute Stroke Risk (CARS) scheme enables an individualized estimation of 1-year absolute risk of stroke in AF. We aimed to investigate the predicted and absolute risks of ischaemic stroke, and evaluate whether CARS (and CHA2DS2-VASc score) may be useful for identifying high risk patients with AF despite contemporary treatment.METHODS: We utilized the EORP-AF General Long-Term Registry which prospectively enrolled patients with AF from 250 centres across 27 participating European countries. Patients with sufficient data to determine CARS and CHA2DS2-VASc score, and reported outcomes of ischaemic stroke were included in this analysis. The primary outcome of ischaemic stroke was recorded over a 2-year follow-up period.RESULTS: A total of 9444 patients were included (mean age 69.1 [±11.4] years; 3776 [40.0%] females). There was a high uptake (87.9%) of anticoagulation therapy, predominantly with vitamin K antagonist (50.0%). Over a mean follow-up period of 24 months, there were a total of 101 (1.1%) ischaemic stroke events. In the entire cohort, the median CARS and absolute annual risks of ischaemic stroke were 2.60 (IQR 1.60-4.00) and 0.53% (95%CI 0.43-0.64%), respectively. There was no statistical difference between the predictive performance of CARS and CHA2DS2-VASc score (0.621 [95%CI 0.563-0.678] vs. 0.626 [95%CI 0.573-0.680], P = 0.725).CONCLUSION: Contemporary management of AF was associated with a low risk of ischaemic stroke. CARS and CHA2DS2-VASc score may be useful to identify high risk patients despite treatment who may benefit from more aggressive treatment and follow-up.

AB - BACKGROUND: Risk stratification in patients with atrial fibrillation (AF) is important to facilitate guideline-directed therapies. The Calculator of Absolute Stroke Risk (CARS) scheme enables an individualized estimation of 1-year absolute risk of stroke in AF. We aimed to investigate the predicted and absolute risks of ischaemic stroke, and evaluate whether CARS (and CHA2DS2-VASc score) may be useful for identifying high risk patients with AF despite contemporary treatment.METHODS: We utilized the EORP-AF General Long-Term Registry which prospectively enrolled patients with AF from 250 centres across 27 participating European countries. Patients with sufficient data to determine CARS and CHA2DS2-VASc score, and reported outcomes of ischaemic stroke were included in this analysis. The primary outcome of ischaemic stroke was recorded over a 2-year follow-up period.RESULTS: A total of 9444 patients were included (mean age 69.1 [±11.4] years; 3776 [40.0%] females). There was a high uptake (87.9%) of anticoagulation therapy, predominantly with vitamin K antagonist (50.0%). Over a mean follow-up period of 24 months, there were a total of 101 (1.1%) ischaemic stroke events. In the entire cohort, the median CARS and absolute annual risks of ischaemic stroke were 2.60 (IQR 1.60-4.00) and 0.53% (95%CI 0.43-0.64%), respectively. There was no statistical difference between the predictive performance of CARS and CHA2DS2-VASc score (0.621 [95%CI 0.563-0.678] vs. 0.626 [95%CI 0.573-0.680], P = 0.725).CONCLUSION: Contemporary management of AF was associated with a low risk of ischaemic stroke. CARS and CHA2DS2-VASc score may be useful to identify high risk patients despite treatment who may benefit from more aggressive treatment and follow-up.

KW - Absolute stroke risk

KW - Aged

KW - Anticoagulants/therapeutic use

KW - Atrial Fibrillation/complications

KW - Atrial fibrillation

KW - Brain Ischemia/diagnosis

KW - CARS

KW - CHA2DS2-VASc score

KW - EORP-AF

KW - Female

KW - Humans

KW - Ischaemic stroke

KW - Ischemic Stroke

KW - Male

KW - Predictive stroke risk

KW - Registries

KW - Risk Assessment

KW - Risk Factors

KW - Stroke/diagnosis

KW - CHA DS -VASc score

UR - http://www.scopus.com/inward/record.url?scp=85148254244&partnerID=8YFLogxK

U2 - 10.1093/europace/euac214

DO - 10.1093/europace/euac214

M3 - Journal article

C2 - 36427202

SN - 1099-5129

VL - 25

SP - 277

EP - 282

JO - Europace

JF - Europace

IS - 2

M1 - euac214

ER -

Contemporary management of atrial fibrillation and the predicted vs. absolute risk of ischaemic stroke despite treatment: a report from ESC-EHRA EORP-AF Long-Term General Registry

Abstract

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Keywords

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