Early neurological outcomes according to CHADS2 score in stroke patients with non-valvular atrial fibrillation

Background and purpose:  A higher CHADS₂ score or CHA₂DS₂‐VASc score is associated with an increased risk of ischaemic stroke in patients with non‐valvular atrial fibrillation (NVAF). However, there are no data regarding early neurological outcomes after stroke according to the risk levels. Methods: In this study, a total of 649 stroke patients with NVAF were enrolled and categorized into three groups: low‐risk (CHADS₂ score of 0–1), moderate‐risk (CHADS₂ score 2–3), or high‐risk group (CHADS₂ score ≥4). CHA₂DS₂‐VASc score was divided into four groups including 0–1, 2–3, 4–5, and ≥6. We investigated whether there were differences in initial stroke severity, early neurological outcome, and infarct size according to CHADS₂ score or CHA₂DS₂‐VASc score in stroke patients with NVAF. Results: The initial National Institutes of Health Stroke Scale (NIHSS) score was highest in high‐risk group [9.5, interquartile range (IQR) 4–18], followed by moderate‐risk (8, IQR 2–17) and low‐risk group (6, IQR 2–15) (P = 0.012). Likewise, initial stroke severity increased in a positive fashion with increasing the CHA₂DS₂‐VASc score. During hospitalization, those in the high‐risk group or higher CHA₂DS₂‐VASc score had less improvement in their NIHSS score. Furthermore, early neurological deterioration (END) developed more frequently as CHADS₂ score or CHA₂DS₂‐VASc score increased. Multivariate analysis showed being in the high‐risk group was independently associated with END (OR 2.129, 95% CI 1.013–4.477). Conclusions: Our data indicate that patients with NVAF and higher CHADS₂ score or CHA₂DS₂‐VASc score are more likely to develop severe stroke and a worse clinical course is expected in these patients after stroke presentation.