Limitations of CHADS2 Scoring System in Predicting Stroke Risk - Need to change the Age Criteria

introduction: Atrial fibrillation (AF) is the most common arrhythmia with a strong association with age. The aim of this study was to evaluate the rate of stroke in relation to age and anticoagulation status based on CHADS2 risk criteria. Methods: This study included all patients with non-valvular atrial fibrillation admitted to our clinic between 1/11/2007 and 1/11/2009, with minimum one year follow up for patients without stroke. We calculated risk based on CHADS2 (C-cardiac failure, H- hypertension, A-age >75 years, D-diabetes mellitus, S-stroke) point system and evaluated anticoagulation status at the moment of first occurrence of stroke. We observed the rate of stroke in different group age. Results: The average of participants with AF was 67.9±10.3 years. Amongst 302 patients with non-valvular atrial fibrillation, 32.5% had been anticoagulated while 13.9% of experienced stroke . The stroke were more present in patients who used aspirin in age group 65-74 (22.5%, P=0.014). The mean age of patients who experienced stroke were 67.2, SD±10.8 vs 71.6, SD±5.1, P=0.000. Of the patients with stroke from age group 65-74 years, 23 were in CHADS2 0-1 scoring system. Conclusion: The higher rate of stroke was in the 65-74 years age group, with CHADS2 scoring system 0-1, and without anticoagulation therapy. Therefore modification has to be considered for the CHADS2 scoring system to account the age as a risk factor for population in different regions.