Abstract 15425: Is Accurate Stroke Risk ssessment with CHADS 2 Necessary in Managing Patients with Atrial Fibrillation? Insights from the Stroke Prevention and Rhythm Interventions in Atrial Fibrillation (SPRINT-AF) Registry

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Introduction: Guidelines have advocated use of scoring schemes such as CHADS 2 to assess stroke risk for patients with atrial fibrillation (AF). However, recent studies had demonstrated poor agreement between physician-reported and scoring-derived stroke risk. From a national registry, we assessed if rates of oral anticoagulant (OAC) use differ between patients whose stroke risks are concordantly or discordantly categorized. Methods: From December 2012 to July 2013, a cross-sectional analysis of 936 consecutive AF patients was performed, enrolled from 109 primary care and specialty practices in 10 Canadian provinces. Based on clinical judgment, physicians categorized each patient as low, moderate, or high risk for stroke. We categorized patients’ stroke risk based on their CHADS 2 score (low: 0; moderate: 1, high: ≥2). Agreement between physician-reported and CHADS 2 risk was reported by the weighted kappa. We compared rates of OAC use between patients whose stroke risk was concordantly or discordantly categorized by clinicians, relative to those derived from CHADS 2 . Results: Complete data were available in 929 (98.8%) patients for analysis. The weighted kappa between physician-reported and CHADS 2 -derived stroke risk was 0.41 (95% CI: 0.34 to 0.48). Physician-determined stroke risk was concordantly categorized to CHADS 2 scores in 544 (58.6%) patients. Among patients with CHADS 2 ≥2, rates of OAC use were similar between the concordant and discordant groups (91.7% vs. 90.4%, p=0.66). For patients with CHADS 2 =1, rates of OAC use were higher in the concordant group (84.2% vs. 66.4%, p<0.01). For patients with CHADS 2 =0, rates of OAC use were lower in the concordant group (43.5% vs. 80.0%, p<0.01). Conclusions: In this contemporary AF registry, the agreement between physician-reported and CHADS 2 -derived stroke risk was only modest. Despite this, the rate of OAC use in patients at high risk (CHADS 2 ≥2) was similarly high between the concordant and discordant groups. However, rates of OAC use between the 2 groups differed among patients at lower stroke risk. Our results suggest that discrepancy in stroke risk categorization is associated with guideline-discordant OAC use, particularly for patients with lower CHADS 2 scores.