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Predicting the Risk of Ischemic Stroke among Patients with Rheumatoid Arthritis Using a Simplified RA-CHADSV Score Based on the CHA2DS2-VASc Score

by Chia-Wen Hsu 1,2,†, Khai-Jing Ng 3,†, Ming-Chi Lu 3,4 and Malcolm Koo 5,6,*
1
Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi 62247, Taiwan
2
School of Nursing, College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan
3
Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi 62247, Taiwan
4
School of Medicine, Tzu Chi University, Hualien City, Hualien 97004, Taiwan
5
Graduate Institute of Long-term Care, Tzu Chi University of Science and Technology, Hualien City, Hualien 97005, Taiwan
6
Dalla Lana School of Public Health, University of Toronto, Toronto, M5T 3M7 ON, Canada
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Medicina 2020, 56(2), 73; https://doi.org/10.3390/medicina56020073
Received: 2 January 2020 / Revised: 4 February 2020 / Accepted: 6 February 2020 / Published: 12 February 2020
Background and Objectives: The aim of this retrospective cohort study was to develop a new score (RA-CHADSV) (rheumatoid arthritis - congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack/thromboembolism, and vascular disease), modified from the CHA2DS2-VASc score (congestive heart failure, hypertension, age ≥75 years (doubled), diabetes mellitus, stroke/transient ischemic attack (doubled), vascular disease, age 65–74 years, and female), in predicting the risk of ischemic stroke in rheumatoid arthritis (RA) patients without atrial fibrillation (AF). Materials and Methods: Using the Taiwan’s National Health Insurance Research Database, 592 patients with RA diagnosed between 2000 and 2002 were identified and followed until first occurrence of ischemic stroke or the last available date in the database. Incidence rate ratios (IRR) of ischemic stroke for the CHA2DS2-VASc score were calculated using Poisson regression models. A new prediction score RA-CHADSV was developed using multiple logistic regression analysis with bootstrap validation. Results: The area under the receiver operating characteristic curve of the newly developed RA-CHADSV score and the CHA2DS2-VASc score were 0.73 (95% confidence interval (CI) 0.64–0.82) and 0.70 (95% CI 0.61–0.79), respectively. The RA-CHADSV score was significantly associated with a higher ischemic stroke incidence in the patients who scored ≥1 (adjusted IRR 7.39, p < 0.001). Conclusions: A simplified RA-CHADSV score, with comparable efficiency as the CHA2DS2-VASc score, but easier to use clinically was developed for predicting the risk of ischemic stroke among non-AF RA patients.
Keywords: stroke; rheumatoid arthritis; atrial fibrillation; brain ischemia; risk assessment stroke; rheumatoid arthritis; atrial fibrillation; brain ischemia; risk assessment
MDPI and ACS Style

Hsu, C.-W.; Ng, K.-J.; Lu, M.-C.; Koo, M. Predicting the Risk of Ischemic Stroke among Patients with Rheumatoid Arthritis Using a Simplified RA-CHADSV Score Based on the CHA2DS2-VASc Score. Medicina 2020, 56, 73.

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