In Asian AF patients, females have 13-26% higher stroke risk than males at high CHA2DS2-VA scores; CHA2DS2-VASc outperforms CHA2DS2-VA in stroke prediction.
Does the CHA2DS2-VASc score improve ischemic stroke risk prediction compared to the sex-less CHA2DS2-VA score in Asian patients with atrial fibrillation?
Retaining female sex as a component of the CHA2DS2-VASc score enhances stroke prediction and discrimination in Asian AF patients, challenging the 2024 European guidelines recommendation to use the sex-less CHA2DS2-VA score.
Absolute Event Rate: 0% vs 0%
Abstract Background The 2024 European guidelines for atrial fibrillation (AF) recommended use of the sex-less CHA2DS2-VASc score (ie. CHA2DS2-VA) for stroke risk assessment, albeit with Level of Evidence C. As evidence is limited in Asian AF patients, our aim was firstly, to perform temporal analysis of stroke risks of AF females versus males; and secondly, to compare the performance of CHA2DS2-VASc versus CHA2DS2-VA scores. Methods This study used the Taiwan National Health Insurance Research Database from 2000 to 2021. The comparisons between CHA2DS2-VASc and CHA2DS2-VA scores were assessed using net reclassification index (NRI), integrated discrimination improvement (IDI) and C-statistics among AF patients diagnosed in different time periods (with 2-year intervals). Results We analyzed 495,569 non-anticoagulated newly diagnosed AF patients (44% women). Risks of ischemic stroke were consistently higher in females compared to males for AF patients diagnosed in different calendar years with the incidence rate ratio (IRR) ranging from 1.13 to 1.26 (all p values 0.05)(Figure 1). In patients with a CHA2DS2-VA score of 0-1, females had a lower risk of ischemic stroke compared to males (IRR = 0.81, p0.001; score 1: IRR = 0.88, p0.001). In the higher score categories, females showed consistently higher ischemic stroke risk (CHA2DS2-VA scores 2-8) with an IRR ranging from 1.04 to 1.11 (all p values 0.05). The CHA2DS2-VASc score improved the NRI by 7.5% to 11.3% compared with the CHA2DS2-VA score over the whole study period (p value 0.001 for each 2-year time interval period). Based on the IDI, the CHA₂DS₂-VASc was superior to CHA₂DS₂-VA score during year 2000 to 2015, but had a similar discriminative capacity in more recent years (2016-2021). The C-statistics of the CHA₂DS₂-VASc score were slightly higher than the CHA₂DS₂-VA score between year 2000 to 2013 (all p values 0.05) and were nonsignificant thereafter (p 0.05 for years 2014-2021)(Figure 2). Conclusions AF females have a higher stroke risk than males only in high CHA2DS2-VA score categories, suggesting female sex is more likely to be a risk modifier of stroke in AF. Retaining female sex as a component of the CHA2DS2-VASc score enhanced the prediction and discrimination for stroke events in Asian AF patients.
Chao et al. (Sat,) reported a other. In Asian AF patients, females have 13-26% higher stroke risk than males at high CHA2DS2-VA scores; CHA2DS2-VASc outperforms CHA2DS2-VA in stroke prediction.