Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2015;68:485-91 - Vol. 68 Num.06 DOI: 10.1016/j.rec.2014.06.027

The CHADS2 Score to Predict Stroke Risk in the Absence of Atrial Fibrillation in Hypertensive Patients Aged 65 Years or Older

Pedro Morillas a,, Vicente Pallarés b, Lorenzo Fácila c, Jose Luis Llisterri d, María Eugenia Sebastián e, Manuel Gómez a, Elena Castilla a, Raquel Camarasa a, Miriam Sandin a, Antonio García-Honrubia a

a Servicio de Cardiología, Hospital General Universitario de Elche, Elche, Alicante, Spain
b Unidad de Vigilancia de la Salud, Unión de Mutuas, Departamento de Medicina, Universitat Jaume I, Castellón, Spain
c Servicio de Cardiología, Hospital General de Valencia, Valencia, Spain
d Centro de Salud Joaquín Benlloch, Valencia, Spain
e Servicio de Anestesia y Reanimación, Hospital General Universitario de Elche, Elche, Alicante, Spain

Keywords

Systemic arterial hypertension. Stroke. Coagulation.

Abstract

Introduction and objectives

The CHADS2 score is a proven, essential tool for estimating cardioembolic risk (mainly stroke) in patients with nonvalvular atrial fibrillation, with the purpose of determining the indication for anticoagulant therapy. In this study we analyzed the use of CHADS2 in hypertensive patients without known atrial fibrillation in a Mediterranean population.

Methods

The study included 887 hypertensive patients aged 65 years or older without atrial fibrillation or anticoagulant therapy, who attended a medical consultation. Data on the patients’ main risk factors, cardiovascular history, and medication were collected, basic laboratory analyses and electrocardiography were performed, and the CHADS2 score (heart failure, hypertension, age ≥ 75 years, diabetes mellitus, and previous stroke or transient ischemic attack) was calculated. A clinical follow-up was carried out, recording hospital admissions for a stroke or transient ischemic attack. The median duration of follow-up was 804 days.

Results

Mean age was 72.5 (SD,5.7) years, 46.6% were men, 27.8% had diabetes, and 8.6% were smokers. During follow-up, 40 patients were hospitalized for a stroke or transient ischemic attack (4.5%). The event-free survival analysis showed significant differences according to the CHADS2 score (log rank test, P < .001). On multivariate analysis, smoking and CHADS2 ≥3 were independent predictors of stroke or transient ischemic attack.

Conclusions

The CHADS2 may be useful for estimating the risk of stroke or transient ischemic attack in hypertensive patients without known atrial fibrillation.

1885-5857/© 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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