CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk

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Calculates stroke risk for patients with atrial fibrillation, possibly better than the CHADS2 score, but likely worse than the logistic regression based variant (C-index: 0.606).

Research authors: Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ.

Details Custom formula Study characteristics Files & References

★

Model author

Dr.Ir. R.J. Mentink

Model ID

161

Version

1.5

Revision date

2016-07-18

Specialty

Cardiology

MeSH terms

Atrial Fibrillation

Clinical Prediction Rule

Stroke

Model type

Linear model ^{(Calculation)}

Status

public

Rating

★

Formula
No Formula defined yet

Condition	Formula

Additional information

CHA2DS2-VASc score (Birmingham 2009) was developed after identifying additional stroke risk factors in patients with atrial fibrillation.
Validation study included 1,084 patients with non-valvular AF, not on anticoagulation, over age 18 with EKG or Holter diagnosed AF in the ambulatory and hospital settings from 182 hospitals in 35 countries from 2003 to 2004 and had known thromboembolic status at 1 year from the Euro Heart Survey database.
End point used was stroke or other thromboembolic event.
Used previously developed Birmingham 2009 schema, under the acronym CHA2DS2-VASc.
Study showed that as CHA2DS2-VASc score increased, rate of thromboembolic event within 1 year in non-anticoagulated patients with non-valvular AF increased as well.
Considered score of 0 to be low risk for TE events (none seen in cohort at one year), score of 1 intermediate risk (0.6% rate at 1 year), and greater than 1 high risk (3% rate at 1 year).
oints to keep in mind:
31% of the patients in their original study group were lost to follow-up at one year and thus were not included in the analysis. These patients could have had thromboembolic events, causing them to be lost to follow-up.
There was no statistically significant difference found between the CHA2DS2-VASc and CHADS2 risk stratification schema in predicting TE events.
None of the included patients were anticoagulated. Those at particularly high risk for a TE event may have been already anticoagulated by their PMD, potentially skewing the TE rates.
A subsequent study examining the performance of CHA2DS2-VASc in predicting TE events on anticoagulated patients also identified CAD and smoking as potential additional risk factors for TE in this subset of patients. However, that study also did not show a statistical difference in the predictive avarious risk stratification abilities of the scores.

Study Population

Total population size: 1084

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Females: {{ model.numberOfFemales }}

Continuous characteristics

Name	Mean	SD	Unit
Age	66	14	years
Systolic blood pressure	139	23	mmHg
Left ventricular ejection fraction	53	14	%

Name	LL	Q1	Median	Q3	UL	Unit
te	12	23	66	134	222	t

Categorical characteristics

Name	Subset / Group	Nr. of patients
Age	≥75	309
	<75	775
Past medical history: stroke	Yes	45
	No	1039
Past medical history: transient ischemic attack	Yes	46
	No	1038
Past medical history: other systemic embolism	Yes	6
	No	1078
Past medical history: coronary artery disease	Yes	412
	No	672
Past medical history: peripheral vascular disease	Yes	62
	No	1022
Past medical history: hypertension	Yes	729
	No	355
Past medical history: diabetes mellitus	Yes	187
	No	897
Past medical history: heart failure	Yes	253
	No	831
Drugs: ACE inhibitor/angiotensin II receptor blocker	Yes	607
	No	477
Drugs: Statins	Yes	252
	No	834
Drugs: antiplatetelet drugs	Yes	802
	No	282

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Result interpretation

This model calculates stroke risk for patients with atrial fibrillation. The CHA2DS2-VASc risk score (acronym: Birmingham 2009) fared marginally better (C-statistic, 0.606) than CHADS(2). However, those classified as low risk by the CHA2DS2-VASc and NICE schema were truly low risk with no TE events recorded, whereas TE events occurred in 1.4% of low-risk CHADS(2) subjects. When expressed as a scoring system, the CHA2DS2-VASc showed an increase in TE rate with increasing scores (P value for trend = .003).

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

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Disclaimer: Calculations alone should never dictate patient care, and are no substitute for professional judgement.

Additional information

Study Population

Continuous characteristics

Categorical characteristics

Related files

Supporting Publications

CHA2DS2-VASc Score:
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Supporting Publications

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