Better prediction of stroke in atrial fibrillation with incorporation of cancer in CHA2DS2VASC score: CCHA2DS2VASC score

Brandon Bungo, Pulkit Chaudhury, Michael Arustamyan, Rishi Rikhi, Muzna Hussain, Patrick Collier, Mohamed Kanj, Alok A. Khorana, Amgad Mentias, Rohit Moudgil*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

Introduction: Atrial fibrillation (AF) is associated with an increased risk of stroke. Despite evidence linking cancer and thrombosis, cancer is not part of the CHA2DS2VASc score. Hypothesis: Cancer is an independent risk factor for thromboembolic stroke in patients with AF. Method: The SEER database was utilized to identify patients with lung, colon, breast, and prostate cancers with AF and no prior diagnosis of stroke and. compared to controls within the dataset. The primary endpoint was rates of stroke per 100 person-years. Cox regression modeling and a nested model comparing CHA2DS2VASc score (Model 1) with a complete model including cancer diagnosis (Model 2) were performed. Models were compared using Akaike Information Criterion (AIC) and Net Reclassification Index (NRI). A propensity-matched cohort with equivalent CHA2DS2VASc scores determining stroke-free survival was also performed. Results: A total of 101,185 patients were included in the analysis, with 48,242 in the Cancer and 52,943 in the Non-cancer Group. Stroke rate per 100 person-years was significantly higher in the Cancer Group. The CHA2DS2VASc model (Model 1) was compared against a model including cancer (Model 2) showing improved predictability as assessed by both NRI and AIC. Cox regression analysis calculated a hazard ratio of 1.085 for Cancer, which was comparable to age >75, female sex, and diabetes. Propensity matched Kaplan-Meier curve demonstrated a decreased probability of stroke-free survival in the Cancer Group. Conclusion: Cancers increase the risk of stroke in patients with AF. Consideration should be given to the addition of cancer to the clinical scoring system.

Original languageEnglish (US)
Article number101072
JournalIJC Heart and Vasculature
Volume41
DOIs
StatePublished - Aug 2022

Funding

Dr. Khorana acknowledges research support from the Sondra and Stephen Hardis Endowed Chair and the National Heart, Lung, and Blood Institute ( U01HL143402 ).

Keywords

  • Atrial fibrillation
  • Cancer
  • CHADs2VAsc Score
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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