Adding Black Race To Scoring System Improves Stroke Prediction in AFib

MedicalResearch.com Interview with:

Dr. Mary Vaughan Sarrazin PhD Associate Professor Department of Internal Medicine University of Iowa Roy and Lucille Carver College of Medicine, and Iowa City VA Medical Center, Center for Comprehensive Access & Delivery Research and Evaluation (CADRE) Iowa City

Dr. Mary Vaughan Sarrazin

Dr. Mary Vaughan Sarrazin PhD
Associate Professor
Department of Internal Medicine
University of Iowa Roy and Lucille Carver College of Medicine, and
Iowa City VA Medical Center, Center for Comprehensive Access & Delivery
Research and Evaluation (CADRE)
Iowa City

MedicalResearch.com: What is the background for this study?

Response: Atrial fibrillation is associated with a higher risk of stroke. The CHA2DS2VASc score (congestive heart failure, hypertension, age 75 or older, diabetes, previous stroke, vascular disease, age 65-74, female sex) reflects stroke risk and is used to guide decisions regarding anticoagulation. Our prior work suggests that African Americans have a higher risk of stroke compared to other patients with atrial fibrillation, even after risk factor adjustments. In the current study, we used Medicare data to test whether addition of black race to CHA2DS2VASc score improves stroke prediction in patients with atrial fibrillation.

MedicalResearch.com: What are the main findings?

Response: Results demonstrated that addition of black race to the CHA2DS2VASc score (‘CHA2DS2VASc-R’) improves stroke prediction, based on an improved log likelihood ratio statistic (p<0.001), Net Reclassification Improvement (NRI), and Integrated Discrimination Improvement (IDI). Among the individual risk factors in the CHA2DS2-VASc-R score, only prior stroke, age ≥75 years, and female gender had stronger associations with incident stroke than black race.

MedicalResearch.com: What should readers take away from your report?

Response: The readers should recognize that African Americans with atrial fibrillation are at a higher risk of stroke than patients of other race and ethnicities. We recommend a new scoring system (CHA2DS2VASc-R) for stroke prediction and decision making regarding anticoagulation in patients with atrial fibrillation which includes the addition of black race as a stroke risk factor.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: As our study included Medicare patients over the age of 65 years, we recommend future studies to study the modified CHA2DS2VASc-R score in younger population. Factors that contribute to the increased stroke risk in African Americans should be studied.

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