Evidence map›Paper›PMID 24139523›Full record

ArticleThe American journal of medicine2013

Does CHA2DS2-VASc improve stroke risk stratification in postmenopausal women with atrial fibrillation?

Joellyn M Abraham, Joseph Larson, Mina K Chung, Anne B Curtis, Kamakshi Lakshminarayan, Jonathan D Newman, Marco Perez, Kathryn Rexrode, Nawar M Shara, Allen J Solomon and 4 more

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The American journal of medicine, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 3 pooled it
1.4field-weighted citation impact, top 16% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 3 syntheses or guidelines pooled it, 15 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Review
  5. Observational
  6. Article
  7. Article
  8. Observational
  9. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 11 institutions in 1 country.

Joellyn M AbrahamDepartment of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. Electronic address: abrahaj3@ccf.org.
Joseph Larson
Mina K Chung
Anne B Curtis
Kamakshi Lakshminarayan
Jonathan D Newman
Marco Perez
Kathryn Rexrode
Nawar M Shara
Allen J Solomon
Marcia L Stefanick
James C Torner
Bruce L Wilkoff
Sylvia Wassertheil-Smoller
Cleveland Clinic · USStanford University · USAlbert Einstein College of Medicine · USBrigham and Women's Hospital · USColumbia University · USGeorgetown-Howard Universities Center for Clinical and Translational Science · USGeorge Washington University · USUniversity at Buffalo, State University of New York · USUniversity of Iowa · USUniversity of Minnesota · USWomen's Health Initiative · US

Funding

Functional Genomics of Atrial Fibrillation in Human AtriaR01HL111314 · NHLBI · CLEVELAND CLINIC LERNER COM-CWRU · PI BARNARD, JOHN, CHUNG, MINA KAY · 2012 to 2019
$6.1M
Unruptured Intracranial Aneurysms: Neurologic OutcomeR01NS048597 · NINDS · UNIVERSITY OF IOWA · PI TORNER, JAMES C · 2004 to 2007
$1.9M
NHLBI NIH HHS HHSN268201100001CNHLBI NIH HHS HHSN268201100001INHLBI NIH HHS HHSN268201100002CNHLBI NIH HHS HHSN268201100002INHLBI NIH HHS HHSN268201100003CNHLBI NIH HHS HHSN268201100003INHLBI NIH HHS HHSN268201100004CNHLBI NIH HHS HHSN268201100004INHLBI NIH HHS HHSN268201100046CNHLBI NIH HHS R01 HL111314NIA NIH HHS HHSN271201100004CNIDA NIH HHS HHSN271201100004CNINDS NIH HHS R01 NS048597WHI NIH HHS HHSN268201100001CWHI NIH HHS HHSN268201100002CWHI NIH HHS HHSN268201100003CWHI NIH HHS HHSN268201100004C
6 · The paper itself

Abstract

backgroundRisk stratification of atrial fibrillation patients with a congestive heart failure (C), hypertension (H), age ≥ 75 (A), diabetes (D), stroke or transient ischemic attack (TIA) (S2) (CHADS2) score of <2 remains imprecise, particularly in women. Our objectives were to validate the CHADS2 and congestive heart failure (C), hypertension (H), age ≥ 75 (A2), diabetes (D), stroke, TIA or prior thromboembolic disease (S2)- vascular disease (V), age 65-74 (A), female gender (S) (CHA2DS2-VASc) stroke risk scores in a healthy cohort of American women with atrial fibrillation and to determine whether CHA2DS2-VASc further risk-stratifies individuals with a CHADS2 score of <2.

methodsWe identified a cohort of 5981 women with atrial fibrillation not on warfarin at baseline (mean age 65.9 ± 7.2 years) enrolled in the Women's Health Initiative and followed for a median of 11.8 years. Univariate and multivariate proportional hazards analyses were used to examine these 2 risk scores, with main outcome measures being annualized event rates of ischemic stroke or transient ischemic attack stratified by risk score.

resultsAnnualized stroke/transient ischemic attack rates ranged from 0.36% to 2.43% with increasing CHADS2 score (0-4+) (hazard ratio [HR] 1.57; 95% confidence interval [CI], 1.45-1.71 for each 1-point increase) and 0.20%-2.02% with increasing CHA2DS2-VASc score (1-6+) (HR 1.50; 95% CI, 1.41-1.60 for each 1-point increase). CHA2DS2-VASc had a higher c statistic than CHADS2: 0.67 (95% CI, 0.65-0.69) versus 0.65 (95% CI, 0.62-0.67), P <.01. For CHADS2 scores <2, stroke risk almost doubled with every additional CHA2DS2-VASc point.

conclusionsAlthough both CHADS2, and CHA2DS2-VASc are predictive of stroke risk in postmenopausal women with atrial fibrillation, CHA2DS2-VASc further risk-stratifies patients with a CHADS2 score <2.

Indexed as

AgedAtrial FibrillationCardiovascular DiseasesCohort StudiesDiabetes ComplicationsFemaleHeart FailureHumansMiddle AgedMultivariate AnalysisPostmenopauseProportional Hazards ModelsResearch DesignRisk FactorsStrokeWomen's HealthAtrial fibrillationCHA(2)DS(2)-VAScCHADS(2)StrokeWomen

Identifiers

PMID24139523
PMCPMC3883047
OpenAlexW2074866385

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.