The CHA₂DS₂-VA score demonstrated similar, non-inferior performance compared to the CHA₂DS₂-VASc score for predicting adverse events in patients with atrial fibrillation.
Does the CHA₂DS₂-VA score perform similarly to the CHA₂DS₂-VASc score in predicting adverse events in patients with atrial fibrillation?
The CHA₂DS₂-VA score is a simplified, sex-neutral tool endorsed by the 2024 ESC guidelines that performs similarly to the CHA₂DS₂-VASc score for assessing thromboembolic risk in AF patients.
The CHA₂DS₂-VASc score is a validated clinical tool for estimating the annual risk of thromboembolic events, including ischaemic stroke in patients with atrial fibrillation (AF). The novel CHA₂DS₂-VA score is a simplified, sex-neutral tool, endorsed by the European Society of Cardiology (ESC) guidelines for the management of AF patients 2024, for assessing the risk of adverse events (i.e., mortality, stroke, arterial thromboembolism) in AF patients. In the derivation cohort, women had similar adjusted risks of stroke or arterial thromboembolism as compared to men, with sex adding no predictive value for the primary endpoint. In fact, CHA₂DS₂-VA showed similar (i.e., non-inferior) performance to CHA₂DS₂-VASc with no interaction with sex, supporting the removal of sex to improve clinical usability. Limitations of the study by Champsi et al. include the use of a composite primary endpoint (mortality, stroke, arterial thromboembolism), which may obscure differences in individual outcomes, and the exclusion of patients aged ≥75 years, limiting generalizability to older populations. Moreover, patients with a history of previous stroke were excluded from the above study, with prior stroke representing an important determinant of ischaemic risk. Pending additional validation studies, CHA₂DS₂-VA can guide oral anticoagulation decisions, recommending OAC for scores ≥2 (Class I, Level C; ESC guidelines 2024) and considering it for a score of 1 (Class IIa, Level C; ESC guidelines 2024) through shared decision-making, considering patient preferences, individual bleeding risk (and proper management thereof if modifiable), and potential contraindications. Note that, in contrast to the ESC, most recent AHA/ASA guidelines do not yet recommend the use of the CHA₂DS₂-VA score.
Simon Kraler (Wed,) conducted a review in Atrial fibrillation. CHA₂DS₂-VA Score vs. CHA₂DS₂-VASc Score was evaluated on Composite of all-cause mortality, ischaemic stroke, and arterial thromboembolism. The CHA₂DS₂-VA score demonstrated similar, non-inferior performance compared to the CHA₂DS₂-VASc score for predicting adverse events in patients with atrial fibrillation.