April 25, 2025European Heart Journal - Cardiovascular PharmacotherapyOpen Access

Stroke risk stratifications according to CHA2DS2-VASc vs. CHA2DS2-VA in patients with atrial fibrillation: insights from the GLORIA-AF registry

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Why the study?

Whether adopting the sex-independent CHA2DS2-VA score instead of the CHA2DS2-VASc score is beneficial for stroke risk stratification in AF patients remains controversial.

Does the CHA2DS2-VA score perform similarly to the CHA2DS2-VASc score in stratifying the risk of ischaemic stroke and thromboembolism in patients with atrial fibrillation?

Structured PICO

Does the CHA2DS2-VA score perform similarly to the CHA2DS2-VASc score in stratifying the risk of ischaemic stroke and thromboembolism in patients with atrial fibrillation?

Population

21,260 patients with atrial fibrillation from the global, multicentre, prospective GLORIA-AF Registry Phase III, mean age 70.2 ± 10.3 years, 44.9% female.

Intervention

Risk stratification using the CHA2DS2-VA score (sex-independent version)

Comparator

Risk stratification using the CHA2DS2-VASc score

Outcome

Ischaemic stroke and thromboembolism (TE)hard clinical

The sex-independent CHA2DS2-VA score has similar predictive performance for thromboembolic events compared with the CHA2DS2-VASc score in patients with atrial fibrillation.

Implication

CHA2DS2-VA may serve as alternative to CHA2DS2-VASc in AF; hypothesis-generating for sex-independent scoring pending prospective validation.

Abstract

AIMS: Whether the adoption of CHA2DS2-VA score, the sex-independent version of the CHA2DS2-VASc score is beneficial for stratifying risk of stroke in patients with atrial fibrillation (AF) remains controversial. METHODS AND RESULTS: Utilizing the data from the global, multicentre and prospective GLORIA-AF Registry Phase III, we compared the performances of CHA2DS2-VA and CHA2DS2-VASc scores in stratifying the risk of ischaemic stroke and thromboembolism (TE), and compared the risk of ischaemic stroke and TE, and the use of oral anticoagulants in male and female patients with AF. A total of 21 260 AF patients with available data were included in the analysis (mean age 70.2 ± 10.3 years, 44.9% female). Overall, female patients were less likely prescribed with oral anticoagulant (OAC) compared with males [odds ratio: 0.90, 95%confidence interval [CI]: (0.83-0.97)]. A significant interaction (P < 0.001) between sex and age was observed, with a lower likelihood of receiving OAC among younger female patients.The risk of ischaemic stroke [hazard ratio (HR):1.14, 95%CI: (0.85-1.53)] and TE [HR: 1.02, 95%CI: (0.82-1.26)] was similar between male and female patients, and the predictive ability of the two scores was similar for both outcomes: TE [area under the receiver operating characteristic curve (AUC): 0.641, 95%CI: (0.585-0.697) vs. AUC: 0.636, 95%CI: (0.580-0.692); P = 0.593] and ischaemic stroke [AUC: 0.660, (95%CI: 0.582-0.739) vs. AUC: 0.646, (95%CI: 0.568-0.725); P = 0.847]. There was a possible interaction between sex and age observed, with a higher risk of TE in younger female patients (P = 0.051). CONCLUSION: CHA2DS2-VA score had similar predictive performance for thromboembolic events compared with CHA2DS2-VASc score. The role of female sex in the management and outcomes of patients with AF may differ according to age. Whether the omission of the female criterion from CHA2DS2-VA would lead to less OAC use in female AF patients over the next years remains to be seen.