This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (385)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Neurology  • Cerebrovascular Disease  • Stroke  • Cardiovascular System  • Arrhythmias  • Endocrine Diseases  • Diabetes Mellitus  • Congestive Heart Failure/ Cardiomyopathy  • Hypertension  • Alert me on articles by topic  Social Bookmarking   What's this?

Results From the National Registry of Atrial Fibrillation

Brian F. Gage, MD,MSc; Amy D. Waterman, PhD; William Shannon, PhD; Michael Boechler, PhD; Michael W. Rich, MD; Martha J. Radford, MD

JAMA. 2001;285:2864-2870.

Context  Patients who have atrial fibrillation (AF) have an increased risk of stroke, but their absolute rate of stroke depends on age and comorbid conditions.

Objective  To assess the predictive value of classification schemes that estimate stroke risk in patients with AF.

Design, Setting, and Patients  Two existing classification schemes were combined into a new stroke-risk scheme, the CHADS₂ index, and all 3 classification schemes were validated. The CHADS₂ was formed by assigning 1 point each for the presence of congestive heart failure, hypertension, age 75 years or older, and diabetes mellitus and by assigning 2 points for history of stroke or transient ischemic attack. Data from peer review organizations representing 7 states were used to assemble a National Registry of AF (NRAF) consisting of 1733 Medicare beneficiaries aged 65 to 95 years who had nonrheumatic AF and were not prescribed warfarin at hospital discharge.

Main Outcome Measure  Hospitalization for ischemic stroke, determined by Medicare claims data.

Results  During 2121 patient-years of follow-up, 94 patients were readmitted to the hospital for ischemic stroke (stroke rate, 4.4 per 100 patient-years). As indicated by a c statistic greater than 0.5, the 2 existing classification schemes predicted stroke better than chance: c of 0.68 (95% confidence interval [CI], 0.65-0.71) for the scheme developed by the Atrial Fibrillation Investigators (AFI) and c of 0.74 (95% CI, 0.71-0.76) for the Stroke Prevention in Atrial Fibrillation (SPAF) III scheme. However, with a c statistic of 0.82 (95% CI, 0.80-0.84), the CHADS₂ index was the most accurate predictor of stroke. The stroke rate per 100 patient-years without antithrombotic therapy increased by a factor of 1.5 (95% CI, 1.3-1.7) for each 1-point increase in the CHADS₂ score: 1.9 (95% CI, 1.2-3.0) for a score of 0; 2.8 (95% CI, 2.0-3.8) for 1; 4.0 (95% CI, 3.1-5.1) for 2; 5.9 (95% CI, 4.6-7.3) for 3; 8.5 (95% CI, 6.3-11.1) for 4; 12.5 (95% CI, 8.2-17.5) for 5; and 18.2 (95% CI, 10.5-27.4) for 6.

Conclusion  The 2 existing classification schemes and especially a new stroke risk index, CHADS₂, can quantify risk of stroke for patients who have AF and may aid in selection of antithrombotic therapy.

Author Affiliations: Divisions of General Medical Sciences (Drs Gage, Waterman, and Shannon) and Cardiology (Dr Rich), Washington University School of Medicine, St Louis, Mo; Innovative Emergency Management Inc, Baton Rouge, La (Dr Boechler); and Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Conn (Dr Radford).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

June 13, 2001
JAMA. 2001;285(22):2921-2922.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Role of the CHADS(2) Score in the Evaluation of Thromboembolic Risk in Patients With Atrial Fibrillation Undergoing Transesophageal Echocardiography Before Pulmonary Vein Isolation.
Puwanant et al.
J Am Coll Cardiol 2009;54:2032-2039.
ABSTRACT | FULL TEXT  

Outcome of atrial fibrillation among patients with end-stage renal disease
Chou et al.
Nephrol Dial Transplant 2009;0:gfp589v1-gfp589.
ABSTRACT | FULL TEXT  

Left Atrial Appendage Occlusion Eliminates the Need for Warfarin
Holmes and Schwartz
Circulation 2009;120:1919-1926.
FULL TEXT  

The RE-LY study: Randomized Evaluation of Long-term anticoagulant therapY: dabigatran vs. warfarin
Camm
Eur Heart J 2009;30:2554-2555.
FULL TEXT  

Quality of life of elderly people on warfarin for atrial fibrillation
Das et al.
Age Ageing 2009;38:751-754.
FULL TEXT  

Atrial Arrhythmias in Adults With Congenital Heart Disease
Bouchardy et al.
Circulation 2009;120:1679-1686.
ABSTRACT | FULL TEXT  

Atrial fibrillation and long-term prognosis in patients hospitalized for heart failure: results from heart failure survey in Israel (HFSIS)
Shotan et al.
Eur Heart J 2009;0:ehp422v1-ehp422.
ABSTRACT | FULL TEXT  

The Intersection of Risk and Benefit: Is Warfarin Anticoagulation Suitable for Atrial Fibrillation in Patients on Hemodialysis?
Sood et al.
Chest 2009;136:1128-1133.
ABSTRACT | FULL TEXT  

The Relationship Between Daily Atrial Tachyarrhythmia Burden From Implantable Device Diagnostics and Stroke Risk: The TRENDS Study
Glotzer et al.
Circ Arrhythm Electrophysiol 2009;2:474-480.
ABSTRACT | FULL TEXT  

Warfarin Use Associates with Increased Risk for Stroke in Hemodialysis Patients with Atrial Fibrillation
Chan et al.
J. Am. Soc. Nephrol. 2009;20:2223-2233.
ABSTRACT | FULL TEXT  

Quality of care for atrial fibrillation among patients hospitalized for heart failure.
Piccini et al.
J Am Coll Cardiol 2009;54:1280-1289.
ABSTRACT | FULL TEXT  

New Therapies for Stroke Prevention in Atrial Fibrillation: The Long Road to Enhanced Efficacy
Freedman and Gersh
Circulation 2009;120:1024-1026.
FULL TEXT  

Dabigatran versus Warfarin in Patients with Atrial Fibrillation
Connolly et al.
NEJM 2009;361:1139-1151.
ABSTRACT | FULL TEXT  

Twenty-Four-Hour Holter Monitor Follow-Up Does Not Provide Accurate Heart Rhythm Status After Surgical Atrial Fibrillation Ablation Therapy: Up to 12 Months Experience With a Novel Permanently Implantable Heart Rhythm Monitor Device
Hanke et al.
Circulation 2009;120:S177-S184.
ABSTRACT | FULL TEXT  

The Net Clinical Benefit of Warfarin Anticoagulation in Atrial Fibrillation
Singer et al.
ANN INTERN MED 2009;151:297-305.
ABSTRACT | FULL TEXT  

Do Current Guidelines Result in Overuse of Warfarin Anticoagulation in Patients With Atrial Fibrillation?
Hart and Halperin
ANN INTERN MED 2009;151:355-356.
FULL TEXT  

Cost-Effectiveness of Genotype-Guided Warfarin Dosing for Patients With Atrial Fibrillation
Patrick et al.
Circ Cardiovasc Qual Outcomes 2009;2:429-436.
ABSTRACT | FULL TEXT  

Continue or withhold oral anticoagulation in high-risk patients undergoing pacemaker or ICD implantation
Daubert and Mabo
Eur Heart J 2009;0:ehn491v1-ehn491.
FULL TEXT  

Antithrombotic therapy and outcomes of patients with atrial fibrillation following primary percutaneous coronary intervention: results from the APEX-AMI trial
Lopes et al.
Eur Heart J 2009;30:2019-2028.
ABSTRACT | FULL TEXT  

Percutaneous Left Atrial Appendage Occlusion for Patients in Atrial Fibrillation Suboptimal for Warfarin Therapy: 5-Year Results of the PLAATO (Percutaneous Left Atrial Appendage Transcatheter Occlusion) Study
Block et al.
J Am Coll Cardiol Intv 2009;2:594-600.
ABSTRACT | FULL TEXT  

Should Patient Characteristics Influence Target Anticoagulation Intensity for Stroke Prevention in Nonvalvular Atrial Fibrillation?: The ATRIA Study
Singer et al.
Circ Cardiovasc Qual Outcomes 2009;2:297-304.
ABSTRACT | FULL TEXT  

Early and comprehensive management of atrial fibrillation: Proceedings from the 2nd AFNET/EHRA consensus conference on atrial fibrillation entitled 'research perspectives in atrial fibrillation'
Kirchhof et al.
Europace 2009;11:860-885.
FULL TEXT  

Contemporary Management of Atrial Fibrillation: Update on Anticoagulation and Invasive Management Strategies
Crandall et al.
Mayo Clin Proc. 2009;84:643-662.
ABSTRACT | FULL TEXT  

Current Status of Stroke Risk Stratification in Patients With Atrial Fibrillation
Hart and Pearce
Stroke 2009;40:2607-2610.
FULL TEXT  

Early and comprehensive management of atrial fibrillation: executive summary of the proceedings from the 2nd AFNET-EHRA consensus conference 'research perspectives in AF'
Kirchhof et al.
Eur Heart J 2009;0:ehp235v1-ehp235.
ABSTRACT | FULL TEXT  

The ACTIVE Pursuit of Stroke Prevention in Patients with Atrial Fibrillation
Go
NEJM 2009;360:2127-2129.
FULL TEXT  

Atrial fibrillation and heart failure in cardiology practice: reciprocal impact and combined management from the perspective of atrial fibrillation: results of the Euro Heart Survey on atrial fibrillation.
Nieuwlaat et al.
J Am Coll Cardiol 2009;53:1690-1698.
ABSTRACT | FULL TEXT  

Atrial fibrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications
Schmitt et al.
Eur Heart J 2009;30:1038-1045.
ABSTRACT | FULL TEXT  

Atrial tissue Doppler imaging for prediction of new-onset atrial fibrillation
De Vos et al.
Heart 2009;95:835-840.
ABSTRACT | FULL TEXT  

Prevalence and clinical impact of left atrial thrombus and dense spontaneous echo contrast in patients with atrial fibrillation and low CHADS2 score
Kleemann et al.
Eur J Echocardiogr 2009;10:383-388.
ABSTRACT | FULL TEXT  

Assessment of left atrial appendage function with transthoracic tissue Doppler echocardiography
Uretsky et al.
Eur J Echocardiogr 2009;10:363-371.
ABSTRACT | FULL TEXT  

Efficacy and safety of drug-eluting stent use in patients with atrial fibrillation
Ruiz-Nodar et al.
Eur Heart J 2009;30:932-939.
ABSTRACT | FULL TEXT  

Dilemmas in the Management of Atrial Fibrillation in Chronic Kidney Disease
Reinecke et al.
J. Am. Soc. Nephrol. 2009;20:705-711.
ABSTRACT | FULL TEXT  

Cost-effectiveness of radiofrequency catheter ablation for the treatment of atrial fibrillation in the United Kingdom
McKenna et al.
Heart 2009;95:542-549.
ABSTRACT | FULL TEXT  

The Registry of the German Competence NETwork on Atrial Fibrillation: patient characteristics and initial management
Nabauer et al.
Europace 2009;11:423-434.
ABSTRACT | FULL TEXT  

Coronary Stents and Chronic Anticoagulation
Sourgounis et al.
Circulation 2009;119:1682-1688.
FULL TEXT  

Managing anticoagulated atrial fibrillation patients undergoing endoscopy
Gorard
Gut 2009;58:468-468.
FULL TEXT  

Authors' response
Veitch and Baglin
Gut 2009;58:469-469.
FULL TEXT  

The impact of frailty on the utilisation of antithrombotic therapy in older patients with atrial fibrillation
Perera et al.
Age Ageing 2009;38:156-162.
ABSTRACT | FULL TEXT  

Thrombosis and Antithrombotic Therapy in Women
Bailey et al.
Arterioscler. Thromb. Vasc. Bio. 2009;29:284-288.
ABSTRACT | FULL TEXT  

Stroke in paroxysmal atrial fibrillation: report from the Stockholm Cohort of Atrial Fibrillation
Friberg et al.
Eur Heart J 2009;0:ehn599v1-9.
ABSTRACT | FULL TEXT  

Utility of nongated multidetector computed tomography for detection of left atrial thrombus in patients undergoing catheter ablation of atrial fibrillation.
Martinez et al.
J Am Coll Cardiol Img 2009;2:69-76.
ABSTRACT | FULL TEXT  

CHAPTER 14 Diabetes Mellitus and Metabolic Syndrome
Cosentino et al.
ESC Textbook of Cardiovascular Medicine 2009;2:med-9780199566990-chapter-med-9780199566990-chapter.
ABSTRACT | FULL TEXT  

CHAPTER 29 Atrial Fibrillation
Camm et al.
ESC Textbook of Cardiovascular Medicine 2009;2:med-9780199566990-chapter-med-9780199566990-chapter.
ABSTRACT | FULL TEXT  

Patient-Specific Decision-Making for Warfarin Therapy in Nonvalvular Atrial Fibrillation: How Will Screening With Genetics and Imaging Help? * Supplemental Appendix
Eckman et al.
Stroke 2008;39:3308-3315.
ABSTRACT | FULL TEXT  

Anticoagulation Control in Atrial Fibrillation: Optimizing Risks and Benefits
Alsheikh-Ali and Estes
Circ Cardiovasc Qual Outcomes 2008;1:72-73.
FULL TEXT  

Increased Left Atrial Volume Index: Potent Biomarker for First-Ever Ischemic Stroke
Fatema et al.
Mayo Clin Proc. 2008;83:1107-1114.
ABSTRACT | FULL TEXT  

Racial/Ethnic Differences in Ischemic Stroke Rates and the Efficacy of Warfarin Among Patients With Atrial Fibrillation
Shen et al.
Stroke 2008;39:2736-2743.
ABSTRACT | FULL TEXT  

Atrial fibrillation is associated with impaired cognitive function and hippocampal atrophy: silent cerebral ischaemia vs. Alzheimer's disease?
Goette and Braun-Dullaeus
Eur Heart J 2008;29:2067-2069.
FULL TEXT  

Stroke risk in the elderly: it's not all about visible clot
Kanagaratnam
Heart 2008;94:1109-1110.
FULL TEXT  

Alternatives to warfarin in atrial fibrillation: drugs and devices
Bayard et al.
Heart 2008;94:1113-1116.
FULL TEXT  

Soluble CD40 Ligand, Platelet Surface CD40 Ligand, and Total Platelet CD40 Ligand in Atrial Fibrillation: Relationship to Soluble P-Selectin, Stroke Risk Factors, and Risk Factor Intervention
Choudhury et al.
Chest 2008;134:574-581.
ABSTRACT | FULL TEXT  

Increased Major Bleeding Complications Related to Triple Antithrombotic Therapy Usage in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Artery Stenting
Manzano-Fernandez et al.
Chest 2008;134:559-567.
ABSTRACT | FULL TEXT  

Guidelines for the management of anticoagulant and antiplatelet therapy in patients undergoing endoscopic procedures
Veitch et al.
Gut 2008;57:1322-1329.
FULL TEXT  

Prevention of stroke in patients with atrial fibrillation: current strategies and future directions
Hohnloser et al.
Eur Heart J Suppl 2008;10:H4-H10.
ABSTRACT | FULL TEXT  

Atrial fibrillation management by practice cardiologists: a prospective survey on the adherence to guidelines in the real world
Meiltz et al.
Europace 2008;10:674-680.
ABSTRACT | FULL TEXT  

The Perioperative Management of Antithrombotic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
Douketis et al.
Chest 2008;133:299S-339S.
ABSTRACT | FULL TEXT  

Antithrombotic Therapy in Atrial Fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
Singer et al.
Chest 2008;133:546S-592S.
ABSTRACT | FULL TEXT  

Comparison of 12 Risk Stratification Schemes to Predict Stroke in Patients With Nonvalvular Atrial Fibrillation
Stroke Risk in Atrial Fibrillation Working Group
Stroke 2008;39:1901-1910.
ABSTRACT | FULL TEXT  

Risks and Benefits of Oral Anticoagulation Compared With Clopidogrel Plus Aspirin in Patients With Atrial Fibrillation According to Stroke Risk: The Atrial Fibrillation Clopidogrel Trial With Irbesartan for Prevention of Vascular Events (ACTIVE-W)
Healey et al.
Stroke 2008;39:1482-1486.
ABSTRACT | FULL TEXT  

Catheter ablation for atrial fibrillation
Lubitz et al.
BMJ 2008;336:819-826.
FULL TEXT  

Safety of percutaneous coronary intervention during uninterrupted oral anticoagulant treatment
Karjalainen et al.
Eur Heart J 2008;29:1001-1010.
ABSTRACT | FULL TEXT  

Should we abandon the common practice of withholding oral anticoagulation in paroxysmal atrial fibrillation?
Nieuwlaat et al.
Eur Heart J 2008;29:915-922.
ABSTRACT | FULL TEXT  

Atrial fibrillation subtypes, risk of stroke, and antithrombotic therapy
Stramba-Badiale
Eur Heart J 2008;29:840-842.
FULL TEXT  

Use of Anticoagulation in Elderly Patients with Atrial Fibrillation Who Are at Risk for Falls
Garwood and Corbett
The Annals of Pharmacotherapy 2008;42:523-532.
ABSTRACT | FULL TEXT  

Cardiogenic and aortogenic brain embolism.
Doufekias et al.
J Am Coll Cardiol 2008;51:1049-1059.
ABSTRACT | FULL TEXT  

An update on cardioembolic stroke
Weir
Postgrad. Med. J. 2008;84:133-142.
ABSTRACT | FULL TEXT  

Comparison of Risk Stratification Schemes to Predict Thromboembolism in People With Nonvalvular Atrial Fibrillation
Fang et al.
J Am Coll Cardiol 2008;51:810-815.
ABSTRACT | FULL TEXT  

Anticoagulant and Antiplatelet Therapy Use in 426 Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention and Stent Implantation: Implications for Bleeding Risk and Prognosis
Ruiz-Nodar et al.
J Am Coll Cardiol 2008;51:818-825.
ABSTRACT | FULL TEXT  

ACC/AHA/Physician Consortium 2008 Clinical Performance Measures for Adults With Nonvalvular Atrial Fibrillation or Atrial Flutter: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation) Developed in Collaboration With the Heart Rhythm Society
Estes et al.
J Am Coll Cardiol 2008;51:865-884.
FULL TEXT  

ACC/AHA/Physician Consortium 2008 Clinical Performance Measures for Adults With Nonvalvular Atrial Fibrillation or Atrial Flutter: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation)
Estes et al.
Circulation 2008;117:1101-1120.
FULL TEXT  

Prognostic value of plasma soluble CD40 ligand in patients with chronic non-valvular atrial fibrillation
Duygu et al.
Europace 2008;10:210-214.
ABSTRACT | FULL TEXT  

Highlights of the year in JACC 2007.
DeMaria et al.
J Am Coll Cardiol 2008;51:490-512.
FULL TEXT  

Risk of Thromboembolism With Short-term Interruption of Warfarin Therapy
Garcia et al.
Arch Intern Med 2008;168:63-69.
ABSTRACT | FULL TEXT  

Catheter Ablation Therapy for Supraventricular Arrhythmias
Marine
JAMA 2007;298:2768-2778.
ABSTRACT | FULL TEXT  

Warfarin reduced major stroke more than aspirin in elderly patients with atrial fibrillation in primary care.
Jaffer
Evid. Based Med. 2007;12:172-172.
FULL TEXT  

Atrial fibrillation in the 'real world': undecided issues
Nieuwlaat et al.
Eur Heart J Suppl 2007;9:I122-I128.
ABSTRACT | FULL TEXT  

Improving anticoagulation management in patients with atrial fibrillation
Dager
Am J Health Syst Pharm 2007;64:2279-2280.
FULL TEXT  

ASHP Therapeutic Position Statement on Antithrombotic Therapy in Chronic Atrial Fibrillation
Nutescu
Am J Health Syst Pharm 2007;64:2281-2291.
FULL TEXT  

Increased mortality in paroxysmal atrial fibrillation: report from the Stockholm Cohort-Study of Atrial Fibrillation (SCAF)
Friberg et al.
Eur Heart J 2007;28:2346-2353.
ABSTRACT | FULL TEXT