{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T02:29:58Z","timestamp":1791944998552,"version":"4.3.4"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2021,1,2]],"date-time":"2021-01-02T00:00:00Z","timestamp":1609545600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100005971","name":"German Heart Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005971","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,1,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Patients with atrial fibrillation (AF) and rheumatic heart disease (RHD), especially mitral stenosis, are assumed to be at high risk of stroke, irrespective of other factors. We aimed to re-evaluate stroke risk factors in a contemporary cohort of AF patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We analysed data of 15\u00a0400 AF patients presenting to an emergency department and who were enrolled in the global RE-LY AF registry, representing 47 countries from all inhabited continents. Follow-up occurred at 1\u2009year after enrolment. A total of 1788 (11.6%) patients had RHD. These patients were younger (51.4\u00b115.7 vs. 67.8\u00b113.6\u2009years), more likely to be female (66.2% vs. 44.7%) and had a lower mean CHA2DS2-VASc score (2.1\u00b11.7 vs. 3.7\u00b12.2) as compared to patients without RHD (all P&amp;lt;0.001). Significant mitral stenosis (average mean transmitral gradient 11.5\u00b16.5\u00a0mmHg) was the predominant valve lesion in those with RHD (59.6%). Patients with RHD had a higher baseline rate of anticoagulation use (60.4% vs. 45.2%, P&amp;lt;0.001). Unadjusted stroke rates at 1\u2009year were 2.8% and 4.1% for patients with and without RHD, respectively. The performance of the CHA2DS2-VASc score was modest in both groups [stroke at 1\u2009year, c-statistics 0.69, 95% confidence interval (CI) 0.60\u20130.78 and 0.63, 95% CI 0.61\u20130.66, respectively]. In the overall cohort, advanced age, female sex, prior stroke, tobacco use, and non-use of anticoagulation were predictors for stroke (all P&amp;lt;0.05). Mitral stenosis was not associated with stroke risk (adjusted odds ratio 1.07, 95% CI 0.67\u20131.72, P=0.764).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The performance of the CHA2DS2-VASc score was modest in AF patients both with and without RHD. In this cohort, moderate-to-severe mitral stenosis was not an independent risk factor for stroke.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cvr\/cvaa344","type":"journal-article","created":{"date-parts":[[2020,12,9]],"date-time":"2020-12-09T19:12:37Z","timestamp":1607541157000},"page":"295-304","source":"Crossref","is-referenced-by-count":19,"title":["Stroke risk prediction in patients with atrial fibrillation with and without rheumatic heart disease"],"prefix":"10.1093","volume":"118","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2555-1266","authenticated-orcid":false,"given":"Alexander P","family":"Benz","sequence":"first","affiliation":[{"name":"Division of Cardiology, Population Health Research Institute, McMaster University, 237 Barton St. E. Hamilton, ON L8L 2X2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeff S","family":"Healey","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Population Health Research Institute, McMaster University, 237 Barton St. E. Hamilton, ON L8L 2X2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Chin","sequence":"additional","affiliation":[{"name":"Department of Medicine, The Cardiac Clinic, Groote Schuur Hospital, University of Caape Town, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Commerford","sequence":"additional","affiliation":[{"name":"Department of Medicine, The Cardiac Clinic, Groote Schuur Hospital, University of Caape Town, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara","family":"Marsden","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Population Health Research Institute, McMaster University, 237 Barton St. E. Hamilton, ON L8L 2X2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ganesan","family":"Karthikeyan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6082-7542","authenticated-orcid":false,"given":"William F","family":"McIntyre","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Population Health Research Institute, McMaster University, 237 Barton St. E. Hamilton, ON L8L 2X2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2527-8936","authenticated-orcid":false,"given":"Jorge A","family":"Wong","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Population Health Research Institute, McMaster University, 237 Barton St. E. Hamilton, ON L8L 2X2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albertino","family":"Damasceno","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan H","family":"Hohnloser","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Division of Clinical Electrophysiology, Johann Wolfgang Goethe University, Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9969-3921","authenticated-orcid":false,"given":"Jonas","family":"Oldgren","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0378-6531","authenticated-orcid":false,"given":"Lars","family":"Wallentin","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D","family":"Ezekowitz","sequence":"additional","affiliation":[{"name":"Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Lankenau and Bryn Mawr Hospitals, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John W","family":"Eikelboom","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Population Health Research Institute, McMaster University, 237 Barton St. E. Hamilton, ON L8L 2X2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salim","family":"Yusuf","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Population Health Research Institute, McMaster University, 237 Barton St. E. Hamilton, ON L8L 2X2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart J","family":"Connolly","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Population Health Research Institute, McMaster University, 237 Barton St. E. 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