Development and Validation of a Novel Score for Predicting Paroxysmal Atrial Fibrillation in Acute Ischemic Stroke

Jiann-Der Lee; Ya-Wen Kuo; Chuan-Pin Lee; Yen-Chu Huang; Meng Lee; Tsong-Hai Lee

doi:10.3390/ijerph19127277

Development and Validation of a Novel Score for Predicting Paroxysmal Atrial Fibrillation in Acute Ischemic Stroke

Int J Environ Res Public Health. 2022 Jun 14;19(12):7277. doi: 10.3390/ijerph19127277.

Authors

Jiann-Der Lee^{1

2}, Ya-Wen Kuo^{1

3}, Chuan-Pin Lee⁴, Yen-Chu Huang^{1

2}, Meng Lee^{1

2}, Tsong-Hai Lee^{2

5}

Affiliations

¹ Department of Neurology, Chiayi Chang Gung Memorial Hospital, No. 6, West Sec., Jiapu Road, Puzi City 613, Taiwan.
² College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan 333, Taiwan.
³ Department of Nursing, College of Nursing, Chang Gung University of Science and Technology, No. 2, Sec. W., Jiapu Rd., Puzi City 613, Taiwan.
⁴ Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
⁵ Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.

Abstract

Atrial fibrillation (AF)-whether paroxysmal or sustained-increases the risk of stroke. We developed and validated a risk score for identifying patients at risk of paroxysmal atrial fibrillation (pAF) after acute ischemic stroke (AIS). A total of 6033 patients with AIS who received 24 h Holter monitoring were identified in the Chang Gung Research Database. Among the identified patients, 5290 with pAF and without AF were included in the multivariable logistic regression analysis to develop the pAF prediction model. The ABCD-SD score (Age, Systolic Blood pressure, Coronary artery disease, Dyslipidemia, and Standard Deviation of heart rate) comprises age (+2 points for every 10 years), systolic blood pressure (-1 point for every 20 mmHg), coronary artery disease (+2 points), dyslipidemia (-2 points), and standard deviation of heart rate (+2 points for every 3 beats per minute). Overall, 5.2% (274/5290) of patients had pAF. The pAF risk ranged from 0.8% (ABCD-SD score ≤ 7) to 18.3% (ABCD-SD score ≥ 15). The model achieved an area under the receiver operating characteristic curve (AUROCC) of 0.767 in the model development group. The ABCD-SD score could aid clinicians in identifying patients with AIS at risk of pAF for advanced cardiac monitoring.

Keywords: atrial fibrillation; heart rate; ischemic stroke; risk.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Atrial Fibrillation* / diagnosis
Atrial Fibrillation* / epidemiology
Child
Coronary Artery Disease*
Electrocardiography, Ambulatory
Humans
Ischemic Stroke*
Predictive Value of Tests
Risk Factors
Stroke*

Grants and funding

This work was supported by grants from Chang Gung Memorial Hospital (CGRPG6L0041) and CHING PAO P.D. Charitable Foundation, Taiwan: FCRPF6L0031. The sponsors played no role in the study design, data collection, analysis, or decision to submit the article for publication.