Stroke Risk Classification by Use of the CHADS2 Score in Community Population in Absence of Atrial Fibrillation

Abstract

Objectives: To use CHADS2 and Community Stroke Risk Classification (CSRC) scores to describe and classify the distribution of the risk factors of stroke in a population without known atrial fibrillation (AF). Study Design: Was community, cross-sectional study. Place and Duration of Study: North Africa, among individuals living in capital of Libya (Tripoli); study is done by the community & family medical department, faculty of medicine, University of Tripoli, from 1/1/2010 to 31/12/2014 Methodology: A total of 7497 individuals did not have AF (52.8%male & 48.2% female) who were interviewed by doctors using CHADS2 and CSRC scores. Results: According to both CHADS2 scores and CSRC, about 64.2 %of the study population had at least one risk factor of stroke while 35.8% had no risk factors. Among people having CHADS2 risk score, the majority (41.3%) had an intermediate risk score (P<0.01), which corresponds to an intermediate or moderate stroke risk, and 22.9% have a high risk score which corresponds to a higher stroke risk. According to the CSRC score, the majority of people (44.6%) had intermediate score grades (P<0.001), and 19.6% had a high risk score with three risk factors or more. An intermediate score (1-2 Risk Factors) dominated in all study age groups in comparison to high scores (3-6 Risk Factors) (P<0.001); Hypertension and Diabetes are the major risk factors of stroke in all scores, especially those of intermediate (P<0.001). Finally, in comparison to females, males show a significant increase in all score grades especially in intermediate CHADS2 & CSRC score risk (P<0.004) and this could be related to a genetic-behavior difference. Conclusion: Both the CHADS2 score and CSRC are simple tools that can be used for stroke risk description and assessment among communities of people who do not have atrial fibrillation. In addition, most communities of people have at least one risk factor for stroke, and this corresponds to intermediate scores; the highest risk factors contributing to the intermediate scores are hypertension, diabetes mellitus and being of an age of over forty years. Other risk factors of stroke like congestive heart failure, transient ischemic attack and history of prior stroke usually present among people who have high scores; this means it comes with or as result of other risk factors to form multiple risk factors associated with stroke forming higher scores of CHADS2 and CSRC