Development of a Score to Predict the Paroxysmal Atrial Fibrillation in Stroke Patients: The Screening for Atrial Fibrillation Scale

• Published in: Frontiers in neurology 2022-06, Vol.13, p.900582-900582
• Main Authors: Amaya Pascasio, Laura, Quesada López, Miguel, García-Torrecillas, Juan Manuel, Arjona-Padillo, Antonio, Martínez Sánchez, Patricia
• Format: Article
• Language: English
• Subjects: atrial fibrillation; embolic stroke; embolic stroke of undetermined source; ESUS; ischemic stroke; Neurology
• ISSN: 1664-2295; 1664-2295
• DOI: 10.3389/fneur.2022.900582

Background and PurposeAn individual selection of ischemic stroke patients at higher risk of atrial fibrillation (AF) might increase the diagnostic yield of prolonged cardiac monitoring and render it cost-effective. MethodsThe clinical, laboratory, and brain/cardiac imaging characteristics of consecutive ischemic stroke patients without documented AF were recorded. All patients underwent at least 72 h of cardiac monitoring unless AF was diagnosed before, transthoracic echocardiogram, blood biomarkers, and intracranial vessels imaging. A predictive grading was developed by logistic regression analysis, the screening for atrial fibrillation scale (SAFE). ResultsA total of 460 stroke patients were analyzed to develop the SAFE scale, a 7-items score (possible total score 0-10): age ≥ 65 years (2 points); history of chronic obstructive pulmonary disease or obstructive sleep apnea (1 point); thyroid disease (1 point); NT-proBNP ≥ 250 pg/ml (2 points); left atrial enlargement (2 points); cortical topography of stroke, including hemispheric or cerebellar cortex (1 point); and intracranial large vessel occlusion (1 point). A score = 5 identified patients with paroxysmal AF with a sensitivity of 83% and a specificity of 80%. ConclusionScreening for atrial fibrillation scale (SAFE) is a novel and simple strategy for selecting ischemic stroke patients at higher risk of having AF who can benefit from a more thorough etiological evaluation. External validation of SAFE in a multicenter study, with a larger number of patients, is warranted.