Arrhythmias & electrophysiologyCohort study
Refining the CHA2DS2VASc risk stratification scheme: shall we drop the sex category criterion?
- Retrospective cohort study
- UK primary and secondary care data
Authors' conclusion
Removing Sc from the CHA2DS2VASc score does not affect its ability to discriminate thromboembolic events in the population with AF.
Study context
- Population
- Patients with atrial fibrillation (AF), UK, followed 1998–2016126,428 non-anticoagulated
- Participants
- 195,719 patients
- Exposure
- CHA2DS2VA vs CHA2DS2VASc score
- Outcome
- Ischaemic stroke or systemic embolism
Main finding
As reported in the abstract
Discrimination of thromboembolic events
C-statistics similar for both scores over the years
0.62 to 0.71
Net reclassification improvement (NRI): improved reclassification in lower thromboembolic risk groups
11%
NRI: misclassification in higher-risk patients, without change in anticoagulation indication
−7%
Observational data: associations, not effects.
Further findings
Sex differences in thromboembolic risk
- No sex difference in lower-risk population; higher stroke rates in women with CHA2DS2VA ≥2
Original publication
Refining the CHA2DS2VASc risk stratification scheme: shall we drop the sex category criterion? Europace. Published 10 November 2024. doi:10.1093/europace/euae280
Summarised from the published abstract; every number is checked against it