Use of CHA2DS2-VASc/CHADS2 Score to Predict Paroxysmal Atrial Fibrillation in Patients With Cryptogenic Stroke

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Aims: Paroxysmal atrial fibrillation (PAF) is a possible cause of cryptogenic stroke but is under-diagnosed in this patient cohort. We sought to determine the incidence and predictors of PAF using CHA2DS2-VASc and CHADS2 scores in AF naive cryptogenic stroke patients. Methods: From 2001 to 2010, 327 AF naive cryptogenic stroke patients underwent 24 hour ambulatory holter monitoring. Patient demographics and individual components of the CHADS2 and CHA2DS2-VASc scores were collected from a retrospective review of case records. Results: There were 174 males and 153 females. Mean age was 64.8 years (±13.19). 25 out of 327 (7.65%) were positive for AF. The mean CHADS2 and CHA2DS2-VASc scores were 3.36 (±0.91) and 4.66 (±1.53) respectively. Age was the only independent predictor of PAF. The odds of PAF increased by 1.04 times for each 1 year increase in age (p=0.03). Females, hypertensive, diabetic and cardiac failure patients had higher odds of developing PAF but this was statistically insignificant. The composite CHA2DS2-VASc score was a better predictor of PAF compared to CHADS2 score (p=0.03, p=0.07 respectively). For each unit increase of CHA2DS2-VASc score, the odds of developing PAF increased by 1.37 times (p=0.03). Conclusions: The higher the CHA2DS2-VASc score, the more likely PAF would be detected in cryptogenic stroke patients and anti-coagulation should be considered.