Category: Professional Posters
Purpose: Atrial fibrillation (a-fib), a common cause of cardioembolic stroke, is associated with worse outcomes. The risk assessment of stroke is performed through evaluating CHA2DS2VASc score that takes into consideration one or two points for each identified risk factor. However, stroke prognosis in the hospitals is assessed through Modified Rankin Scale (MRS) which predicts the degree of mortality and disability. The aim of this study was to assess the factors affecting CHA2DS2VASc score in acute stroke settings and analyze if there is any correlation between MRS upon hospital admission and CHA2DS2VASc score.
Methods: A retrospective, multicenter, observational study was conducted on Lebanese hospitals between February and May 2019. Inclusion criteria were patients with ischemic stroke of a-fib origin. The questionnaire covered the following sections: demographic characteristics, past medical history, CHA2DS2VASc score, acute ischemic stroke management, and MRS. MRS was categorized into two categories 0-2 associated with “good prognosis” and >2 “bad prognosis”. Institutional Review Board of the three hospitals approved the study. Statistical analysis was performed using IBM SPSS (Statistical Package for Social Sciences) version 21.0.
Results: From a total number of 146 patients screened for possible enrollment, 82 had a-fib and were included in the study. The mean (± Standard deviation SD) age of the participants was 80.67 (± 6.97) years and 65.6% were females. The majority of the study subjects were hypertensive 84.1% and the most common cardiovascular disease was angina pectoris (36.6%) followed by congestive heart failure (32.9%). Most of the patients were on acetylsalicylic acid (44%) and around 31.7% were on oral anticoagulants before hospital admission. Females had a higher mean CHA2DS2VASc score than males (5.35 and 4.17 respectively) with p-value of 0.02. Patients with dyslipidemia and hypertensive had significantly higher CHA2DS2VASc score of 5.53 and 5.24 respectively with a p-value < 0.01. The mean ± SD for CHA2DS2VASc score and MRS recorded upon hospital admission was 4.93 ± 1.53 and 4.3 ± 1.00 respectively. Patients with MRS > 2 vs 0 -2 upon hospital admission had a significantly higher mean CHA2DS2VASc score of 5.11 ± 1.42 vs 3.75 ± 2.12 with a p-value of 0.019.
Conclusion: This study suggests the strong correlation between CHA2DS2VASc score and MRS among acute ischemic stroke patients. The findings highlight the important preventive and modifiable lifestyle factors that must be implemented to protect against stroke development. However, pharmacists can play an integral role in lowering disease progression by effective patient counseling about the underlying risk factors that increase stroke development.