Arrhythmias & electrophysiology
External validation and comparison of published stroke risk scores in a Chinese cohort of patients with atrial fibrillation
Authors' conclusion
Candidate models did not consistently outperform CHA2DS2-VASc in this external validation; CHA2DS2-VASc remains practical, whereas other models may require population-specific validation and recalibration.
Study context
- Population
- Adults hospitalized with nonvalvular atrial fibrillation (AF) at a Chinese tertiary-care centeradults hospitalized with nonvalvular AF
- Participants
- 1,283 adultsEvents: 103
- Predictors
- 17 published stroke risk models
- Predicted outcome
- ischemic stroke or systemic embolism
Methodological detailsretrospective cohort, single Chinese tertiary-care center, 17 published models systematically retrieved
- Retrospective cohort
- Single Chinese tertiary-care center
- 17 published models systematically retrieved
Model performance
As reported in the abstract
4-year
Uno C-index
CHA2DS2-VASc
0.690
Uno C-index across models (range)
0.572 to 0.767
Further findings
Uno C-index vs CHA2DS2-VASc · 4-year
- GARFIELD-AF 2017, GARFIELD-AF 2021, and ATRIA had higher Uno C-indices than CHA2DS2-VASc
Time-dependent areas under the curve
- No model had a significantly higher time-dependent areas under the curve at any time point
Calibration · 1-year
- CHA2DS2-VASc predicted risk
- 3.39%
- CHA2DS2-VASc observed risk
- 3.54%
- CHA2DS2-VASc observed-to-expected ratio
- 1.04
- Several other models underestimated the risk
Brier scores and reclassification measures
- No consistent advantage
Competing-risk analyses (death as competing event)
- Lowered the cumulative incidence without changing comparative patterns
- Sensitivity analysis
Patients not receiving oral anticoagulant at baseline (subgroup)
- No model outperformed CHA2DS2-VASc
- Sensitivity analysis
Incidence of primary outcome · 4 years of follow-up
- Primary outcomes
- 103
- Events per 100 person-years
- 2.85
Original publication
External validation and comparison of published stroke risk scores in a Chinese cohort of patients with atrial fibrillation. Heart Rhythm. Published 3 September 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →