CHADS2 and Risk

It is amazing the power of numbers to predict, and our inability to accurately judge risk. The CHADS Score predicts the risk of stroke on a yearly basis, depending on the number of risk factors you have. Most people understand that risk calcultion, but more worrisome is the likelihood of the event occuring given time. I have calculated 1 year risk, but then also placed the 5, 10, 15 and 20 year risk for stroke using the same estimated frequency. I think that many people would make different choices about anticoagulation if they recognized the cumulative risk.

CHADS2 Score Stroke Risk % Year 1 Year 5 Year 10 Year 15 Year 20
0.0 1.9 1.9 9.1 17.5 25.0 31.9
1.0 2.8 2.8 13.2 24.7 34.7 43.3
2.0 4.0 4.0 18.5 33.5 45.8 55.8
3.0 5.9 5.9 26.2 45.6 59.8 70.4
4.0 8.5 8.5 35.9 58.9 73.6 83.1
5.0 12.5 12.5 48.7 73.7 86.5 93.1
6.0 18.2 18.2 63.4 86.6 95.1 98.2

Another way of presenting that same data is, if you have two of the CHADS risk factors for stroke, you have a 18.5% risk for stroke in the next 5 years and a 33.5% risk in the next 10 years. I think that would help guide the decision to take Coumadin, which is the standard recommendation if you have a CHADS score of 2.

Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ (2001). “Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation”. JAMA 285 (22): 2864–70. doi:10.1001/jama.285.22.2864. PMID 11401607
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