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Journal of the American College of Cardiology

Clinical Articles, News & Views

Stroke in AF patients – what does CHA2DS2-VASc really tell us?

The risk of ischaemic stroke in patients with atrial fibrillation (AF) and a CHA2DS2-VASc score of 1 seems to be lower than previously reported, with the risk associated with that score differing markedly between studies, according to a study published recently in the Journal of the American College of Cardiology.1

The authors conducted a retrospective study of 140,420 patients with AF in Swedish nationwide health registries on the basis of varying definitions of “stroke events”. Using a wide “stroke” diagnosis (including hospital discharge diagnoses of ischaemic stroke as well as unspecified stroke, transient ischaemic attack, and pulmonary embolism) yielded a 44% higher annual risk than if only ischaemic strokes were counted.

Including stroke events in conjunction with the index hospitalisation for AF doubled the long-term risk beyond the first 4 weeks. For women, annual stroke rates varied between 0.1% and 0.2% depending on which event definition was used; for men, the corresponding rates were 0.5% and 0.7%.

An accompanying editorial2 from Drs Daniel Singer (Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA) and Michael Ezekowitz (Thomas Jefferson University, Philadelphia, Pennsylvania, USA) points out two important contributions in the study: “First, they highlight the wide cohort-to-cohort variation in reported CHA2DS2-VASc-stratified rates of stroke for nonanticoagulated AF patients. Second, they reveal how sensitive estimates of stroke rates are to variations in interrogating administrative databases, which are used repeatedly as sources of “real-world” rates of stroke.”

The editorial also highlights that Friberg et al. underscore “the inappropriate use of transient ischaemic attack as an outcome, false-positive events when stroke codes are secondary diagnoses, and the importance of excluding stroke events recorded shortly after the first AF diagnosis”.2


1. Friberg L, Skeppholm M, Terént A. Benefit of anticoagulation unlikely in patients with atrial fibrillation and a CHA2DS2-VASc score of 1. J Am Coll Cardiol 2015;65:225–32.

2. Singer DE, Ezekowitz MD. Adding rigor to stroke risk prediction in atrial fibrillation*. J Am Coll Cardiol 2015;65:233–5.

Published on: January 29, 2015

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    None Found


  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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