Key result
CHA2DS2-VA shows comparable stroke risk discrimination to CHA2DS2-VASc.
Why the study?
The 2024 European Society of Cardiology guidelines introduced the CHA2DS2-VA score omitting female sex from AF stroke risk stratification, but evidence on its relative predictive performance versus CHA2DS2-VASc across diverse populations remains inconsistent.
Does the CHA2DS2-VA score improve prediction of ischaemic stroke or thromboembolic events compared to the CHA2DS2-VASc score in patients with atrial fibrillation?
Meta-Analysis (n=250,112)
Yes
Does the CHA2DS2-VA score improve prediction of ischaemic stroke or thromboembolic events compared to the CHA2DS2-VASc score in patients with atrial fibrillation?
In patients with atrial fibrillation, the sex-neutral CHA2DS2-VA score demonstrates comparable overall discrimination for stroke and thromboembolism compared to the CHA2DS2-VASc score, particularly in non-anticoagulated patients, though reclassification modestly favors CHA2DS2-VASc.
Answers are grounded in this paper and cite their sources.
May inform simplification of AF stroke scores by omitting female sex; leaves open context-specific reclassification value.
The 2024 European Society of Cardiology guidelines introduced the CHA2DS2-VA score, omitting female sex from stroke risk stratification in atrial fibrillation (AF). However, evidence on the relative predictive performance of CHA2DS2-VA versus CHA2DS2-VASc across diverse populations remains inconsistent. We therefore conducted a systematic evaluation of their discrimination and reclassification performance. We performed a systematic review and meta-analysis of observational cohort studies comparing CHA2DS2-VA and CHA2DS2-VASc for prediction of ischaemic stroke or thromboembolic events in patients with AF. Discrimination was evaluated using the difference in C-statistics (ΔAUC) and integrated discrimination improvement (IDI), and reclassification using continuous net reclassification improvement (NRI). Pooled estimates were derived using random-effects models. Seven studies including 250,112 patients were analysed. In the overall population, discriminative performance was comparable between the CHA2DS2-VA and CHA2DS2-VASc scores (ΔAUC 0.00065, 95% CI −0.00288 to 0.00417; IDI 0.00010, 95% CI −0.00063 to 0.00083). Continuous NRI indicated a modest advantage for CHA2DS2-VASc (−0.05615; 95% CI: −0.10350 to −0.00880). Among patients not receiving oral anticoagulation, both discrimination and reclassification were similar between the two scores. Variability in reclassification performance was observed across regions and study periods. The CHA2DS2-VA and CHA2DS2-VASc scores showed comparable discrimination for stroke risk prediction in patients with AF when evaluated as continuous scores, although reclassification modestly favoured the CHA2DS2-VASc score. The clinical contribution of female sex to risk prediction appears context-dependent and warrants further evaluation.
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Yeh et al. (2026) conducted a meta-analysis in Atrial fibrillation (n=250,112). CHA2DS2-VA score vs. CHA2DS2-VASc score was evaluated on Ischaemic stroke or thromboembolic events (ΔAUC 0.00065, 95% CI -0.00288 to 0.00417). CHA2DS2-VA showed comparable stroke risk discrimination to CHA2DS2-VASc (ΔAUC 0.00065, 95% CI -0.00288 to 0.00417), though continuous NRI modestly favored CHA2DS2-VASc (-0.05615).
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