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
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 sc...
| Autores: | , , , , , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2016 |
| País: | España |
| Institución: | Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO) |
| Repositorio: | r-FISABIO. Repositorio Institucional de Producción Científica |
| OAI Identifier: | oai:fisabio.fundanetsuite.com:p2253 |
| Acceso en línea: | https://fisabio.portalinvestigacion.com/publicaciones/2253 |
| Access Level: | acceso abierto |
| Palabra clave: | atrial fibrillation stroke risk score oral anticoagulation antithrombotic treatment CHA(2)DS(2)-VASc score |
| Sumario: | 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. |
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