ATRIA Risk Score

[Slattery]

I am confused , the Atria score tells me I am at low risk of stroke, the Chad score tells me I am at medium rick. Which system do I follow?

[Hidden]

The Chad scale seems too blunt to me in the sense that anything 1 or above is enough to prescribe anticoagulants. I haven't tried the Atria scale but will look into it.

[Buffafly]

Have you read the recent post on anticoagulation? If it is up to you to decide it is a difficult decision if you are reluctant to take an anticoagulant. Nobody can say for sure what is best for you so you may as well go with your gut instinct. Mine is to take the anticoagulant and be aware that I am at a higher risk of a brain haemorrhage or other bleed because the thought of a bad stroke scares me more. You just have to make a decision and move on.

[BobD Volunteer]

Risk is still risk. Up to you but to me CHADS2VASC is the gold standard,

[Hennerton]

I have just done some searching and it seems that in a Swedish study, Atria performed better than Chadsvasc 2 in predicting stroke. Does anyone have any comments on this?

[CaroleF in reply to Hennerton]

I have just read this article here:

neurologyadvisor.com/stroke...

I think the conclusion is more nuanced than you state since they say:

"Overall, the ATRIA score performed better than the CHADS2 and CHA2DS2-VASc risk scores. The results persisted even after restricting analysis to more recent follow-up, excluding unspecified strokes, and excluding renal dysfunction as a predictor. Most improvements with ATRIA were the result of down classification, suggesting that using the CHA2DS2-VASc risk score could lead to overtreatment of patients at very low risk of stroke. " (my embolding)

Not sure that this is the same study as the one to which you are referring though.

My own conclusion? Look at both scores if you have Lone AF (ie no comorbidities). Thereafter, "you pays your money and you takes your choice." I doubt that there is a one size fits all solution to the dilemma of 'anti-coagulation, or not?' and in the last resort I'd follow the advice of my doctor since I am not medically trained, not a medical researcher and have no real experience in evaluating statistics in this context.

[Hennerton]

Thanks for your reply. I am no wiser and I suspect it will always be like that, How can one system work for each individual and get it right every time. It is all a lottery...

[CDreamer in reply to Hennerton]

There are no absolutes and there never will be - too many variables to consider - and until we have individual profiling all predictors will be based upon 'herd statistics' probability prediction, which won't be that accurate for an individual.

[MarkS]

The main difference between the scoring systems is that Atria gives a far higher score for previous stroke. For instance you can be age 74, have high blood pressure and diabetes and the Atria system will still consider you low risk if you have not had a previous stroke!

So you pretty much have to have had a previous stroke to be classified as anything other than low risk on the Atria system. That's not exactly much use if you're trying to prevent your first stroke!!

[Offcut in reply to MarkS]

I have got to agree it is reducing the chance of stroke in the first place. I have multi-conditions with all sorts of complications on treatment so I have a higher INR ideal than most plus I am not always aware I am in AF?

Be well