Abstract WP246: CHA 2 DS 2 -VASC Score Predicts Outcomes After a Stroke or Transient Ischemic Attack

Abstract

Introduction: The CHA 2 DS 2 -VASC score is used to predict stroke in people with atrial fibrillation (AF). We determined the utility of this score for predicting outcomes within one-year post-stroke/TIA. Methods: Analysis of adults with acute stroke/TIA (2012-2016) using linked data from the Australian Stroke Clinical Registry and administrative datasets (pharmaceutical, hospital, Medicare), as part of the PRECISE study. CHA 2 DS 2 -VASC score (ranging from 0-9) was estimated based on comorbidities documented in hospital data as of the time of acute stroke/TIA. Outcomes included health-related quality of life (HRQoL) at 90-180 days post-stroke/TIA; and all-cause mortality and hospital readmissions (all-cause, cardiovascular disease) within 1 year post-stroke/TIA. HRQoL was assessed using the EuroQoL 5D-3L visual analogue scale (VAS) score, ranging from 0 (worst health) - 100 (best health), and across health domains (mobility, self-care, usual activities, pain/discomfort, anxiety/depression). Regression models were used to determine associations with outcomes, with risk estimates were expressed per 1-point increase in CHA 2 DS 2 -VASC score, and adjusted for covariates (e.g. use of medications) and interaction with AF history. Results: Of 12,613 eligible participants (median age 74 years; 44% female; 26% AF history), the median CHA 2 DS 2 -VASC score was 4 (i.e., high risk; interquartile range 3-6). In multivariable models, greater CHA 2 DS 2 -VASC score was associated with increased rates of mortality (hazard ratio [HR] 1.28 95% CI 1.23-1.33) in people with AF history only. Regardless of AF history, greater CHA 2 DS 2 -VASC score was associated with reduced VAS scores (by -1.57, 95% CI -1.99, -1.15), and increased odds of reporting problems in each HRQoL domain, ranging from odds ratio of 1.36 (95% CI 1.31-1.41) for mobility to 1.05 (95% CI 1.02-1.09) for anxiety/depression. Greater CHA 2 DS 2 -VASC score was also associated with increased rates of readmission for all causes (HR 1.11, 95% CI 1.08-1.14) or cardiovascular causes (HR 1.10; 95% CI 1.05-1.15). Conclusion: CHA 2 DS 2 -VASC score as of the time of acute stroke/TIA is associated with worse long-term outcomes, including HRQoL, within 1 year, and may be useful for risk stratification post-stroke/TIA.