Chest
Original ResearchThromboembolismRefining Clinical Risk Stratification for Predicting Stroke and Thromboembolism in Atrial Fibrillation Using a Novel Risk Factor-Based Approach: The Euro Heart Survey on Atrial Fibrillation
Section snippets
Validation Cohort
To test the predictive ability of the refined Birmingham schema, and to compare this with the performance of other schema, we used the Euro Heart Survey on AF population. Survey methods, center participation, patient characteristics, management and definitions of the baseline and follow-up survey of the Euro Heart Survey on AF have previously been described.21, 22 In summary, 5,333 ambulant and hospitalized patients with AF were enrolled from the cardiology practices of 182 hospitals among 35
Results
The 1,084 patients with nonvalvular AF, who were not on anticoagulation at baseline and for whom we knew TE status at 1 year, were on average 66 years old and 40.8% were women (Table 3). Hypertension was the most prevalent stroke risk factor (67.3%), followed by coronary artery disease (38.4%). Antiplatelet drugs were taken by 74.0%. In univariate analyses, female gender, history of vascular disease, prior stroke/TIA, and diabetes were associated with an increased incidence of TE (all P < .05;
Discussion
In this article, we have provided a validation for a novel risk factor-based approach to stroke risk stratification (Birmingham 2009), in comparison with other published schema, in a real world European cohort. This Birmingham 2009 schema considers patients with a prior stroke/TIA or patients ≥ 75 years as high risk and as candidates for warfarin. Furthermore, a combination of at least two risk factors from hypertension, heart failure, diabetes, age 65 to 75, female gender, and vascular disease
Acknowledgments
Author contributions: Dr Lip: contributed to study design and hypothesis, data interpretation, and drafting and revisions of the manuscript.
Dr Nieuwlaat: contributed to statistical analyses, data interpretation, and drafting of the manuscript.
Dr Pisters: contributed to drafting and revision of the manuscript.
Dr Lane: contributed to drafting and revision of the manuscript.
Dr Crijns: contributed to drafting and revision of the manuscript.
Financial/nonfinancial disclosures: The authors have
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Funding/Support: The Euro Heart Survey is funded by industry sponsors AstraZeneca, Sanofi-Aventis, and Eucomed, and by the Austrian Heart Foundation, Austrian Society of Cardiology, French Federation of Cardiology, Hellenic Cardiological Society, Netherlands Heart Foundation, Portuguese Society of Cardiology, Spanish Cardiac Society, Swedish Heart and Lung Foundation and individual centers.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).