Stroke after Atrial Fibrillation

Stroke after Atrial Fibrillation

Based on
Wang TJ, Massaro JM, Levy D, Vasan RS, Wolf PA, D’Agostino RB, Larson MG, Kannel WB, Benjamin EJ. A risk score for predicting stroke or death in individuals with new-onset atrial fibrillation in the community: the Framingham Heart Study. Jama. 2003 Aug 27;290(8):1049-56. PMID:12941677.

Outcome
Stroke

Duration of follow-up
Maximum of 10 years; mean 4 years; 5-year risk estimated

Population of interest
705 individuals aged 55 – 94 years from the Original and Offspring Cohorts of the Framingham Heart Study meeting the following criteria:

  • had an occurrence of new-onset Atrial Fibrillation (AF)
  • not treated with warfarin at baseline
  • did not have a stroke, transient ischemic attack (TIA), or death within 30 days of AF diagnosis
  • without rheumatic mitral stenosis

Predictors

  • Age
  • Gender
  • Systolic blood pressure
  • Diabetes
  • Prior stroke or ischemic attack

Excel spreadsheet

Score Sheet

Step 1
Age, y Points
55-59 0
60-62 1
63-66 2
67-71 3
72-74 4
75-77 5
78-81 6
82-85 7
86-90 8
91-93 9
>93 10
Step 2
Sex Points
Men 0
Women 6
Step 3
Systolic Blood
Pressure, mm Hg		 Points
<120 0
120-139 1
140-159 2
160-179 3
>179 4
Step 4
Diabetes Points
No 0
Yes 5
Step 5
Prior Stroke or TIA Points
No 0
Yes 6

Step 6

Add Up Points From Steps 1 Through 5
Look Up Predicted 5-Year Risk of Stroke in Table

Predicted 5-year Risk of Stroke or Death
Total Points 5-Year Risk, %
0-1 5
2-3 6
4 7
5 8
6-7 9
8 11
9 12
10 13
11 14
12 16
13 18
14 19
15 21
16 24
17 26
18 28
19 31
20 34
21 37
22 41
23 44
24 48
25 51
26 55
27 59
28 63
29 67
30 71
31 75
Means and Cox Regression Coefficients
Variables Cox Regression Coefficient Risk Factor Mean
Sex (1=Men, 2=Women) 0.650715 1.48
Age, per y 0.029065   75
Systolic Blood Pressure, per mmHg 0.006130 146
Diabetes Mellitus 0.589268 0.15
Prior Stroke/TIA 0.631572 0.14
Baseline Survival at 5 years, S0(5) 0.857100 —

Risk Stroke Calculator

Gender:
M   F
Age:
Systolic Blood Pressure mm Hg:
Cigarette Smoker in Past Year:
Yes   No
Diabetes:
Yes   No
Prior Stroke/Transient Ischemic Attack (TIA):
Yes   No
History of Congestive Heart Failure or Myocardial Infarction:
Yes   No
Significant Murmur (grade 3/6 or higher systolic, any diastolic):
Yes   No
Electrocardiographic Left Ventricular Hypertrophy (LVH):
Yes   No

5-Year Risk of Stroke

0%
Your risk
0%
Comparative
Comparative Risks of Stroke for same age and gender (lowest stroke risk=normal SBP (<120), no diabetes, prior stroke or TIA

5-Year Risk of Stroke or Death

0%
Your risk
0%
Comparative
Comparative Risks of Stroke or Death for same age and gender (lowest stroke/ death risk=normal SBP (<120), no smoking, diabetes, CHF/MI, murmur, or LVH