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The authors wrote that these findings can further identify Asian AF patients who may benefit from stroke prevention .
attack or age ≥75 years . The modified
CHA 2
DS 2
-VASc score used the same calculation , but assumed 1 point for age between 50 and 74 years . In the study population , the median values of the CHA 2
DS 2
-VASc and modified
CHA 2
DS 2
-VASc scores were 3 ( 2-5 ) and 4 ( 2-5 ), respectively .
In the population , 124,271 patients did not receive warfarin or any antiplatelet agents in whom the accuracies of the 2 scores were compared . A total of 15 948 patients had a CHA 2
DS 2
-VASc score 0 ( males ) or 1 ( females ), and 8,654 patients had a modified CHA 2
DS 2
-VASc score 1 ( males ) or 2 ( females ). The latter were categorized into 3 groups — no treatment , antiplatelet therapy , and warfarin — and the risks of ischemic stroke and intracranial hemorrhage were compared .
During a follow-up of 538,653 person years , 21,008 patients ( 16.9 %) sustained an ischemic stroke with and annual risk of 3.9 %. Both scores were significant predictors of ischemic stroke . The C indexes were 0.689 ( 95 % confidence interval [ CI ], 0.684- 0.694 ) for CHA 2
DS 2
-VASc score and 0.708 ( 95 % CI , 0.703-0.712 ) for the modified CHA 2
DS 2
-VASc score ( p < 0.0001 ). The modified CHA 2
DS 2
- VASc score improved the net reclassification index by 3.39 % ( 95 % CI , 2.16-4.59 %; p < 0.0001 ) as compared to the traditional CHA 2
DS 2
-VASc score . For patients with a CHA 2
DS 2
- VASc score of 0 ( male ) or 1 ( female ) who also had a modified CHA 2
DS 2
-
VASc score of 1 ( male ) or 2 ( female ) based on the broader age category , use of warfarin as compared to no antithrombotic therapy was associated with a lower risk of ischemic stroke ( adjusted hazard ratio [ aHR ], 0.70 ; 95 % CI , 0.59-0.84 ; p < 0.001 ) without an increased risk of intracranial hemorrhage ( aHR , 0.95 ; 95 % CI , 0.61-1.46 ; p = 0.804 ). Net clinical benefit favored warfarin therapy over no antithrombotic therapy for all relative weighting factors of intracranial hemorrhage .
The authors wrote that these finds can further identify Asian AF patients who may benefit from stroke prevention . They also proposed an algorithm for stroke prevention using the modified CHA 2
DS 2
-VASc score for these patients . They explain that Asian AF patients with a modified CHA 2
DS 2
- VASc score of 0 ( males ) of 1 ( females ) are truly low risk , and oral anticoagulants would be omitted . For male patients with a modified CHA 2
DS 2
- VASc ≥ 1 and female patients with a modified CHA 2
DS 2
-VASc ≥ 2 , oral anticoagulants should be prescribed , and non-vitamin K antagonist oral anticoagulants are the preferred option because the risk of warfarin-related intracranial hemorrhage and major bleeding is higher in Asians compared to non-Asians .
Chao TF , Lip GY , Liu CJ , et al . Stroke . 2016 ; doi : 10.1161 / STROKEAHA . 116.013880
Tweet All About It
Twitter data have the potential to serve as a source for cardiovascular research and patient communication , according to a recent study published JAMA Cardiology .
Raina M . Merchant , MD , MSHP , et al ., analyzed 550,338 tweets from July 2009 to February 2015 associated with cardiovascular disease , specifically those with the keywords diabetes , myocardial infarction ( MI ), cardiac arrest , heart failure and hypertension . All tweets were in English and could be mapped to a county in the U . S .
The results of the analysis showed that diabetes and MI were among the most tweeted topics , while heart failure was the least ( 200,000 + tweets
“ Twitter may be useful for studying public communications about cardiovascular disease .”
vs . 10,000 , respectively ). Users who tweeted about cardiology were more likely to be female ( 48.8 %) and older than the average Twitter user ( 28.7 vs . 25.4 years old , respectively ). Further , researchers found that the “ data available on Twitter reflect real-time changes in discussion of a disease topic ,” with spikes in tweets identifiable during events such as World Diabetes Day .
According to the study authors , “ Twitter may be useful for studying public communications about cardiovascular disease . The use of Twitter for clinical research is still in its infancy . Its value and direct applications remain to be seen and warrant further exploration .”
In a response to the study authors ’ analysis of Twitter data , Robert Harrington , MD , and Mintu P . Turakhia , MD , MS , noted that “ other uses of social media in areas related to clinical care or research are rapidly being explored , including drug safety surveillance by the U . S . Food and Drug Administration , monitoring of prescription medication abuse , recruitment and conduct of clinical trials , and as an intervention to improve caregiver and peer support for , education in , and management of chronic diseases .”
Sinnenberg L , DiSilvestro CL , Mancheno C , et al . JAMA Cardiol . 2016 ; doi : 10.1001 / jamacardio . 2016.3029
18 CardioSource WorldNews November 2016