Augmented intelligence decision tool for stroke prediction combines factors from CHA2DS2‐VASc and the intermountain risk score for patients with atrial fibrillation. (25th June 2019)

• Record Type: Journal Article
• Authors: Horne, Benjamin D.; Jacobs, Victoria; May, Heidi T.; Graves, Kevin G.; Bunch, T. Jared
• Is Part Of: Journal of cardiovascular electrophysiology. Volume 30:Number 9(2019)
• Page Start: 1452
• Page End: 1461
• Publication Date: 2019-06-25
• Subjects: clinical decision tool -- IMRS -- IMRS‐VASc -- learning health system -- risk stratification; Blood vessels -- Physiology -- Periodicals; Electrophysiology -- Periodicals; Heart -- Physiology -- Periodicals; 612.1
• DOI: 10.1111/jce.13999
• Languages: English
• ISSNs: 1045-3873

Abstract

Abstract: Introduction: CHA2 DS2 ‐VASc and CHADS2 are computationally simple risk prediction tools used to guide anticoagulation decisions for stroke prophylaxis, but they have modest risk discrimination ability and use static dichotomous variables. The Intermountain Mortality Risk Scores (IMRS) are dynamic decision tools using standard clinical laboratory tests. This study derived new stroke prediction scores using variables from both CHA2 DS2 ‐VASc and IMRS. Methods and Results: In outpatients with first atrial fibrillation (AF) diagnosis at the Intermountain Healthcare (females, n = 26 063 males, n = 29 807), sex‐specific "IMRS‐VASc" scores were derived using variables from CHA2 DS2 ‐VASc, warfarin use, the complete blood count, and the comprehensive metabolic profile. Validation was performed in an independent Intermountain outpatient AF cohort (females, n = 11 021; males, n = 12 641). Stroke occurred among 3.1% and 3.1% of females and 2.3% and 2.5% of males in derivation and validation groups, respectively. IMRS‐VASc stratified stroke with similar ability in derivation (c‐statistics, females: c = 0.703, males: c = 0.697) and validation groups (females: c = 0.681, males: c = 0.685). CHA2 DS2 ‐VASc (females: c = 0.581 and c = 0.605; males: c = 0.616 and c = 0.613 in derivation and validation, respectively) and CHADS2 (females: c = 0.581 and c = 0.608; males: c = 0.620 and c = 0.621 in derivation and validation, respectively) were substantially weaker stroke predictors. IMRS was the strongest mortality predictor (females: c = 0.783 and c = 0.782; males: c = 0.796 and c = 0.794 in derivation and validation, respectively) and all scores were poor at predicting bleeding risk. Conclusions: A temporally dynamic risk score, IMRS‐VASc was derived and validated as a predictor of stroke in outpatients with AF. IMRS‐VASc requires further validation and the evaluation of its use in guiding care and treatment decisions for patients with AF.