A risk score for predicting stroke or death in individuals with new-onset atrial fibrillation in the community - The Framingham Heart Study
A risk score for predicting stroke or death in individuals with new-onset atrial fibrillation in the community - The Framingham Heart Study
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DOI：
10.1001/jama.290.8.1049
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发表时间：
2003-08-27
影响因子：
120.7
通讯作者：
Benjamin, EJ
中科院分区：
文献类型：
--
作者：
Wang, TJ;Massaro, JM;Benjamin, EJ
先前的房颤（AF）风险分层方案是基于随机试验队列或医疗保险管理数据库，包括已确诊的房颤患者，并将卒中作为主要结局。目的获得社区新发房颤个体单独卒中和卒中或死亡的风险评分。设计、环境和参与者来自马萨诸塞州弗雷明汉的前瞻性、社区、观察性队列。我们确定了868例新发房颤患者，其中705例在基线时未接受华法林治疗。卒中（缺血性或出血性）和卒中或死亡的风险评分是在随访期间开始使用华法林时进行审查的。根据风险评分和先前公布的4个风险方案，在低风险个体中检查事件发生率。主要结局指标：中风及合并中风或死亡。结果在不使用华法林的平均4.0年随访期间，83名参与者单独发生中风，382名参与者发生中风或死亡。得出中风的风险评分，包括以下风险预测因素：年龄增长、女性、收缩压升高、既往中风或短暂性脑缺血发作以及糖尿病。通过风险评分，14.3%的队列预测5年卒中发生率小于等于7.5%（年平均卒中发生率小于等于1.5%），30.6%的队列预测5年卒中发生率小于等于10%（年平均卒中发生率小于等于2%）。这些低风险组的实际中风率分别为1.1和1.5 / 100人年。以前的风险方案将6.4%至17.3%的受试者分类为低风险，实际卒中发生率为每100人年0.9至2.3次。此外，还提供了中风或死亡的风险评分。结论这些风险评分可用于估计房颤患者发生不良事件的绝对风险，有助于对患者进行咨询和制定治疗决策。
Context Prior risk stratification schemes for atrial fibrillation (AF) have been based on randomized trial cohorts or Medicare administrative databases, have included patients with established AF, and have focused on stroke as the principal outcome.Objective To derive risk scores for stroke alone and stroke or death in community-based individuals with new-onset AF.Design, Setting, and Participants Prospective, community-based, observational cohort in Framingham, Mass. We identified 868 participants with new-onset AF, 705 of whom were not treated with warfarin at baseline. Risk scores for stroke (ischemic or hemorrhagic) and stroke or death were developed with censoring when warfarin initiation occurred during follow-up. Event rates were examined in low-risk individuals, as defined by the risk score and 4 previously published risk schemes.Main Outcome Measures Stroke and the combination of stroke or death.Results During a mean follow-up of 4.0 years free of warfarin use, stroke alone occurred in 83 participants and stroke or death occurred in 382 participants. A risk score for stroke was derived that included the following risk predictors: advancing age, female sex, increasing systolic blood pressure, prior stroke or transient ischemic attack, and diabetes. With the risk score, 14.3% of the cohort had a predicted 5-year stroke rate less than or equal to7.5% (average annual rate less than or equal to1.5%), and 30.6% of the cohort had a predicted 5-year stroke rate less than or equal to10% (average annual rate less than or equal to2%). Actual stroke rates in these low-risk groups were 1.1 and 1.5 per 100 person-years, respectively. Previous risk schemes classified 6.4% to 17.3% of subjects as low risk, with actual stroke rates of 0.9 to 2.3 per 100 person-years. A risk score for stroke or death is also presented.Conclusion These risk scores can be used to estimate the absolute risk of an adverse event in individuals with AF, which may be helpful in counseling patients and making treatment decisions.