The ABC Stroke Risk Score

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The ABC (Age, Biomarkers, Clinical history) risk score has been developed to predict the risk of stroke or systemic embolism in patients with atrial fibrillation. The ABC Stroke Risk Score is internally and externally validated using two clinical trial databases.

This model is intended to be used for patients who have been diagnosed with either paroxysmal, persistent or permanent atrial fibrillation or atrial flutter and with at least one or more of the risk factors. The full inclusion criteria are stated in the intended use.

Research authors: Ziad Hijazi, Johan Lindbäck, John H. Alexander, Michael Hanna, Claes Held, Elaine M. Hylek, Renato D. Lopes, Jonas Oldgren, Agneta Siegbahn, Ralph A.H. Stewart, Harvey D. White, Christopher B. Granger, Lars Wallentin, on behalf of the ARISTOTLE and STABILITY investigators

Version: 3.10

Public
Cardiology
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V-3.10-2187.23.11.03

(01)08720299526402(8012)v3.10(4326)231103(240)2187

Details
Intended purpose
Electronic label
Release Notes

Details
Intended purpose
Electronic label
Release Notes

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The risk of stroke or systemic embolism is:

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The risk of stroke or systemic embolism is: %

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Conditional information

The current model calculates the risk of a stroke or systemic embolism occurring within the next 1, 2, or 3 years.

The ABC risk score was externally validated and compared head-to-head with similar prediction models such as the CHA₂DS₂-VASc score. The external validation of the ABC score resulted in a c-index of 0.66 versus 0.58 for the CHA₂DS₂-VASc score.

Multiple guidelines recommed to include anticoagulant treatment based on the CHA₂DS₂-VASc score. The ESC guideline on the management of atrial fibrillation provides the following recommendations for anticoagulant therapy.

CHA₂DS₂-VASc score = 0: No antiplatelet or anticoagulant treatment recommended
CHA₂DS₂-VASc score = 1: OAC should be considered
CHA₂DS₂-VASc score ≥ 2: Oral anticoagulation indicated

However, the ABC stroke risk score was compared to the CHA₂DS₂-VASc score and showed that several patients with a CHA₂DS₂-VASc score ≥ 2 were at very low risk (<0.3% risk) according to the ABC Stroke Risk Score. In addition, several patients with a CHA₂DS₂-VASc score of 0 showed to be at high risk (>2% risk) of stroke.

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Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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Additional information

Details

Model author

Evidencio.Medical.Devices

Model ID

10298

Version

3.10

Revision date

2023-11-03

Specialty

Cardiology

Model type

R-Script model ^{(Calculation)}

MeSH terms

Atrial Fibrillation

Cardiovascular Stroke

Status

Public

Formula
No Formula defined yet

Condition	Formula

Study characteristics

Additional information

The ABC score was developed and internally validated with a large cohort of atrial fibrillation patients named the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial. The derived model was subsequently externally validated using the STabilization of Atherosclerotic plaque By Initiation of darapLadIb TherapY (STABILITY) trial.

The derivation cohort consisted of 14701 patients. The validation cohort consisted of 1400 patients.
The model was internally validated using 300 bootstrap samples. A uniform shrinkage factor was applied to account for optimism in the model.

The data shown concern the ARISTOTLE cohort.

The ABC Stroke Risk Score has been externally validated by Berg et al. (2018) and by Oldgren et al. (2016). In these studies, the ABC Stroke Risk Score was compared to the CHA₂DS₂-VASc Score and the ATRIA Risk Score. The ABC Stroke Risk Score consistently performed better than the other scores.

To further assess the impact of the ABC risk models, a trial is currently ongoing (NCT03753490).

Study Population

Total population size: 14701

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Females: {{ model.numberOfFemales }}

Continuous characteristics

Name	LL	Median	UL	Unit
Age	19	70	97	years
Troponin I	2	5.4	11230	ng/L
Troponin T	5	10.9	1580	ng/L
NT-proBNP	5	713	31309	ng/L
eGFR	18.3	74	345	mL/min/m2

Categorical characteristics

Name	Subset / Group	Nr. of patients
Current smoker	No	13513
Current smoker	Yes	1188
Permanent or persistent AF	No	2228
Permanent or persistent AF	Yes	12473
Heart failure	No	10146
Heart failure	Yes	4555
Hypertension	No	1833
Hypertension	Yes	12868
Diabetes	No	11069
Diabetes	Yes	3632
Prior stroke/TIA	No	11931
Prior stroke/TIA	Yes	2770
Vascular disease	No	11052
Vascular disease	Yes	3649
Prior myocardial infarction	No	12817
Prior myocardial infarction	Yes	1884
Peripheral arterial disease	No	13983
Peripheral arterial disease	Yes	718

Supporting Publications

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Extra Information

	Evidencio B.V., Irenesingel 19, 7481 GJ Haaksbergen, The Netherlands
	V-3.10-2187.23.11.03
	(01)08720299526402(8012)v3.10(4326)231103(240)2187
	Medical device

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V-3.10-2187.23.11.03

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The risk of stroke or systemic embolism is: %

Conditional information

Details

Study characteristics

Additional information

Study Population

Continuous characteristics

Categorical characteristics

Supporting Publications

Related files

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