External Validation of SAFE Score to Predict Atrial Fibrillation Diagnosis after Ischemic Stroke: A Retrospective Multicenter Study.

Autor: Quesada López M; Neurology, Hospital Universitario Torrecárdenas, Almería, Spain., Amaya Pascasio L; Neurology, Hospital Universitario Torrecárdenas, Almería, Spain., Blanco Madera S; Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain., Pagola J; Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain., Vidal de Francisco D; Neurology, Hospital Universitario de León, León, Spain., de Celis Ruiz E; Neurology, Hospital La Paz Institute for Health Research-IdiPaz (La Paz University Hospital-Universidad Autónoma de Madrid, Spain., Villegas Rodríguez I; Neurology, Hospital Universitario San Cecilio, Granada, Spain., Carneado-Ruiz J; Neurology, Hospital Universitario Puerta de Hierro, Madrid, Spain., García-Carmona JA; Neurology, Hospital Universitario Santa Lucía, Cartagena, Spain., García Torrecillas JM; Emergency and Research Unit, Torrecárdenas University Hospital, 04009 Almería, Spain.; CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.; Instituto de Investigación Biosanitaria Ibs, 18012 Granada, Spain., López Ferreiro A; Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain., Elosua Bayes I; Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain., Rigual Bobillo RJ; Neurology, Hospital La Paz Institute for Health Research-IdiPaz (La Paz University Hospital-Universidad Autónoma de Madrid, Spain., López López MI; Neurology, Hospital Universitario San Cecilio, Granada, Spain., Esain González Í; Neurology, Hospital Universitario Puerta de Hierro, Madrid, Spain., Ortega Ortega MD; Neurology, Hospital Universitario Santa Lucía, Cartagena, Spain., Blanco Ruiz M; Neurology, Hospital Universitario Torrecárdenas, Almería, Spain., Pérez Ortega I; Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain., Lázaro Hernández C; Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain., Fuentes Gimeno B; Neurology, Hospital La Paz Institute for Health Research-IdiPaz (La Paz University Hospital-Universidad Autónoma de Madrid, Spain., Arjona Padillo A; Neurology, Hospital Universitario Torrecárdenas, Almería, Spain., Martínez Sánchez P; Neurology, Hospital Universitario Torrecárdenas, Almería, Spain.; Faculty of Health Science, Health Research Center (CEINSA), University of Almería, Spain.
Jazyk: angličtina
Zdroj: Stroke research and treatment [Stroke Res Treat] 2023 Dec 07; Vol. 2023, pp. 6655772. Date of Electronic Publication: 2023 Dec 07 (Print Publication: 2023).
DOI: 10.1155/2023/6655772
Abstrakt: Introduction: The screening for atrial fibrillation (AF) scale (SAFE score) was recently developed to provide a prediction of the diagnosis of AF after an ischemic stroke. It includes 7 items: age ≥ 65 years, bronchopathy, thyroid disease, cortical location of stroke, intracranial large vessel occlusion, NT-ProBNP ≥250 pg/mL, and left atrial enlargement. In the internal validation, a good performance was obtained, with an AUC = 0.88 (95% CI 0.84-0.91) and sensitivity and specificity of 83% and 80%, respectively, for scores ≥ 5. The aim of this study is the external validation of the SAFE score in a multicenter cohort.
Methods: A retrospective multicenter study, including consecutive patients with ischemic stroke or transient ischemic attack between 2020 and 2022 with at least 24 hours of cardiac monitoring. Patients with previous AF or AF diagnosed on admission ECG were excluded.
Results: Overall, 395 patients were recruited for analysis. The SAFE score obtained an AUC = 0.822 (95% CI 0.778-0.866) with a sensitivity of 87.2%, a specificity of 65.4%, a positive predictive value of 44.1%, and a negative predictive value of 94.3% for a SAFE score ≥ 5, with no significant gender differences. Calibration analysis in the external cohort showed an absence of significant differences between the observed values and those predicted by the model (Hosmer-Lemeshow's test 0.089).
Conclusions: The SAFE score showed adequate discriminative ability and calibration, so its external validation is justified. Further validations in other external cohorts or specific subpopulations of stroke patients might be required.
Competing Interests: The group of authors of the Torrecardenas University Hospital who proposed the present work (MQL, LAP, JGT, AAP, and PMS) overlaps with those who developed the SAFE score. However, these authors have deliberately avoided participating in the statistical analysis of the results, focusing instead on the design of the study, data collection, and drafting of the manuscript.
(Copyright © 2023 Miguel Quesada López et al.)
Databáze: MEDLINE
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