Fig 1.
Outline of our stochastic model.
The occurrence of stroke was modeled as a nonhomogeneous Poisson process, where the hazard depends on age, comorbidities, and individual variability. If any stroke occurred during the pre-diagnosis period, the period between the onset and diagnosis of AF, it was recorded as a prior stroke. Then, after the diagnosis of AF, the individuals were followed for 15 years or until occurrence of the first stroke. For details, see Methods and S1 Appendix.
Fig 2.
Stroke risk in the simulated populations in comparison to stroke risk in a real-world population.
Dot plots of stroke risk in 36 patient populations representing (A) all combinations of risk factors, including 0–5 comorbidities, (B, C) presence or absence of prior stroke, and (D–F) age (categorized as <65, 65–75, or ≥75 years) arranged according to CHA2DS2-VASc scores. Stroke risk is the probability of stroke occurring within 1 year following the diagnosis of AF. Rectangles (▢) denote absence of prior stroke, and triangles (▵) denote presence of prior stroke. Green denotes age <65 years; blue denotes age 65–75 years; red denotes age ≥75 years. Superimposed are the 1-year stroke risks observed in the Danish cohort [16] with point estimates (dots) and their 95% confidence intervals (error bars).
Table 1.
Relative risks (RRs) of stroke by aging, comorbidities, and prior stroke in our model and from previously reported meta-analyses.
Fig 3.
Line graphs showing stroke risk along a pFST of up to 15 years in patient populations representing (A) all combinations of risk factors, including 0–5 comorbidities, (B, C) presence or absence of prior stroke, and (D–F) age (categorized as <65, 65–75, or ≥75 years). Stroke risk is the probability of stroke occurring during the following year. Solid lines denote absence of prior stroke, and dashed lines denote presence of prior stroke. Green denotes age <65 years; blue denotes age 65–75 years; red denotes age ≥75 years. Note that 16 common CHA2DS2-VASc score-wise trajectories resulted.
Fig 4.
CHA2DS2-VASc-wise stroke risks along the pFST.
Line graphs showing stroke risk along a pFST of up to 15 years per initial CHA2DS2-VASc-score for patients (A) without prior stroke and (B) with prior stroke. Stroke risk is the probability of stroke occurring during the following year.
Fig 5.
Adjusted CHA2DS2-VASc scores (adjCVSs) of patients without prior stroke plotted along a 15-year pFST.
Fig 6.
Line graphs showing stroke risk over an rFST of up to 15 years in patient populations representing (A) all combinations of risk factors, including 0–5 comorbidities, (B, C) presence or absence of prior stroke, and (D–F) age (categorized as <65, 65–75, or ≥75 years). Stroke risk is the probability of stroke occurring during the following year. Solid lines denote absence of prior stroke and dotted lines denote presence of prior stroke. Green denotes age <65 years; blue denotes age 65–75 years; red denotes age ≥75 years. Note that 16 common CHA2DS2-VASc score-wise trajectories resulted.
Fig 7.
CHA2DS2-VASc-wise stroke risks over the rFST.
Line graphs showing stroke risk over an rFST of up to 15 years per CHA2DS2-VASc score for patients (A) without prior stroke and (B) with prior stroke. Stroke risk is the probability of stroke occurring during the following year.
Fig 8.
Adjusted CHA2DS2-VASc scores (adjCVSs) of patients without prior stroke over the rFST.
Line graph showing adjCVSs plotted against an rFST of up to 15 years per CHA2DS2-VASc score. For patients with an rFST of 0, the adjCVS is simply the CHA2DS2-VASc score.
Fig 9.
Effects of changes in the mortality parameter and pre-diagnosis period on indicators of the FEE.
(A) Increase in adjCVS after 10 years of pFST in patients with a CHA2DS2-VASc score 1. (B) rFSTs required to reduce stroke risk in patients without prior stroke from CHA2DS2-VASc score 2 to adjCVS 1.5. Solid circles (●) denote a mortality parameter of 0.1, triangles (▲) denote a mortality parameter of 0.2, squares (■) denote a mortality parameter of 0.3, and plus symbols (+) denote a mortality parameter of 0.5.
Table 2.
Effect of violation of the CHA2DS2-VASc scoring scheme on the FEE.