Article,
Comparing CHA2DS2-VA and CHA2DS2-VASc scores for stroke risk stratification in patients with atrial fibrillation: a temporal trends analysis from the retrospective Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) cohort
Contributors
Teppo, Konsta
0000-0002-4460-0994
(Corresponding author)
[1]
Airaksinen, Kari Eino Juhani
0000-0002-0193-568X
[1]
Halminen, Olli
0000-0001-9266-8435
[4]
Haukka, Jari K
0000-0003-1450-6208
[5]
Hartikainen, Juha E K
0000-0003-0847-107X
[6]
Lehto, Mika
0000-0002-8691-5142
[5]
[7]
Affiliations
- [1] University of Turku [NORA names: Finland; Europe, EU; Nordic; OECD];
- [2] Aalborg University [NORA names: AAU Aalborg University; University; Denmark; Europe, EU; Nordic; OECD];
- [3] University of Liverpool [NORA names: United Kingdom; Europe, Non-EU; OECD];
- [4] Aalto University [NORA names: Finland; Europe, EU; Nordic; OECD];
- [5] University of Helsinki [NORA names: Finland; Europe, EU; Nordic; OECD];
(... more)
Abstract
Background Contemporary data have shown a decrease in the ischaemic stroke risk associated with female sex in patients with atrial fibrillation (AF). We evaluated temporal trends in the predictive value of a non-sex CHA2DS2-VASc risk score (ie. CHA2DS2-VA). Methods The FinACAF study covers all patients with incident AF between 2007 and 2018 in Finland from all levels of care. The CHA2DS2-VA score was compared with the CHA2DS2-VASc using continuous and category-based net reclassification indices (NRIs), integrated discrimination improvement (IDI), c-statistics and decision curve analyses. Findings We identified 144,879 anticoagulant naïve patients with new-onset AF between 2007 and 2018 (49.9% women; mean age 72.1 years), of whom 3936 (2.7%) experienced ischaemic stroke during one-year follow-up. Based on both continuous and category-based NRIs, the CHA2DS2-VA score was inferior to the CHA2DS2-VASc in the early years (−0.333 (95% CI −0.411 to −0.261) and −0.118 (95% CI −0.137 to −0.099), respectively). However, the differences attenuated over time, and by the end of the study period, the continuous NRI became non-significant (−0.093 (95% CI −0.165 to 0.032)), whereas the category-based NRI reversed in favor of the CHA2DS2-VA (0.070 (95% CI 0.048–0.087)). The IDI was non-significant in early years (0.0009 (95% CI −0.0024 to 0.0037)), but over time became statistically significant in favor of the CHA2DS2-VA score (0.0022 (95% CI 0.0001–0.0044)). The Cox models fitted with the CHA2DS2-VA and the CHA2DS2-VASc scores exhibited comparable discriminative capability in the beginning of the study (p-value 0.63), but over time marginal differences in favor of the CHA2DS2-VA score emerged (p-value 0.0002). Interpretation In 2007–2008 (when females had higher AF-related stroke risks than males), the CHA2DS2-VASc score outperformed the CHA2DS2-VA score, but the initial differences between the scores attenuated over time. By the end of the study period in 2017–2018 (with limited/no sex differences in AF-related stroke), there was marginal superiority for the CHA2DS2-VA score. Funding This work was supported by the Aarne Koskelo Foundation, The Finnish Foundation for Cardiovascular Research, The Finnish State Research funding, and Helsinki and Uusimaa Hospital District research fund.
