CHA₂DS₂-VASc score and heart rate predict ischemic stroke outcomes in patients with atrial fibrillation

Purpose: To evaluate the factors determining the severity and outcome of ischemic stroke in patients with atrial fibrillation (AF). Methods: Our study examined 210 patients with AF and acute ischemic stroke to investigate the relative risks of age, gender, comorbidities, CHADS2 and CHA 2DS2-VASc scores, warfarin use, heart rate, and blood pressure on stroke severity, hospitalization duration, and mortality rate. Results: Patients with poor outcomes [n = 109, National Institutes of Health Stroke Scale (NIHSS) scores of ≥8] had elevated CHA2DS2-VASc scores [5, interquartile range (IQR) 3-6 versus 4, IQR 2.5-5, p = 0.005] and were older with a female predominance, less prior warfarin use, and a higher heart rate (93 ± 24 versus 84 ± 20 beats/min, p = 0.004) in the emergency department, with a longer duration of hospitalization (24 ± 23 versus 11 ± 12 days, p <0.001) and a higher mortality rate (11.0% versus 0.0%, p = 0.002) than those with better outcomes (n = 101, low NIHSS scores of ≤ 7). Patients who died (n = 12) were older and had a higher NIHSS, CHADS2 (3.5, IQR 2-4.75 versus 2, IQR 1-4, p = 0.040), or CHA2DS2-VASc (5.5, IQR 4-6 versus 4, IQR 3-5, p = 0.046) scores than patients who survived. The multivariate analysis showed that female gender, no prior warfarin use, and heart rate were independent predictors of stroke severity. Conclusions: Our results showed that CHADS2 and CHA2DS2-VASc scores, and heart rate were useful parameters for predicting outcomes in AF patients with stroke.