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

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dc.contributorAalto-yliopistofi
dc.contributorAalto Universityen
dc.contributor.authorTeppo, Konstaen_US
dc.contributor.authorLip, Gregory Yoke Hongen_US
dc.contributor.authorAiraksinen, Kari Eino Juhanien_US
dc.contributor.authorHalminen, Ollien_US
dc.contributor.authorHaukka, Jarien_US
dc.contributor.authorPutaala, Jukkaen_US
dc.contributor.authorMustonen, Pirjoen_US
dc.contributor.authorLinna, Miikaen_US
dc.contributor.authorHartikainen, Juhaen_US
dc.contributor.authorLehto, Mikaen_US
dc.contributor.departmentDepartment of Industrial Engineering and Managementen
dc.contributor.organizationTurku University Hospitalen_US
dc.contributor.organizationUniversity of Liverpoolen_US
dc.contributor.organizationUniversity of Helsinkien_US
dc.contributor.organizationUniversity of Eastern Finlanden_US
dc.contributor.organizationJorvi Hospitalen_US
dc.date.accessioned2024-08-09T11:07:45Z
dc.date.available2024-08-09T11:07:45Z
dc.date.issued2024-08en_US
dc.descriptionPublisher Copyright: © 2024 The Authors
dc.description.abstractBackground: 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.en
dc.description.versionPeer revieweden
dc.format.mimetypeapplication/pdfen_US
dc.identifier.citationTeppo, K, Lip, G Y H, Airaksinen, K E J, Halminen, O, Haukka, J, Putaala, J, Mustonen, P, Linna, M, Hartikainen, J & Lehto, M 2024, ' Comparing CHA 2 DS 2 -VA and CHA 2 DS 2 -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 ', The Lancet Regional Health – Europe, vol. 43, 100967 . https://doi.org/10.1016/j.lanepe.2024.100967en
dc.identifier.doi10.1016/j.lanepe.2024.100967en_US
dc.identifier.issn2666-7762
dc.identifier.otherPURE UUID: bd9097ea-4dd7-4976-94cb-09ac596f8f68en_US
dc.identifier.otherPURE ITEMURL: https://research.aalto.fi/en/publications/bd9097ea-4dd7-4976-94cb-09ac596f8f68en_US
dc.identifier.otherPURE LINK: http://www.scopus.com/inward/record.url?scp=85195592425&partnerID=8YFLogxKen_US
dc.identifier.otherPURE FILEURL: https://research.aalto.fi/files/153264195/Comparing_CHA2DS2-VA_and_CHA2DS2-VASc_scores_for_stroke_risk_stratification_in_patients_with_atrial_fibrillation.pdfen_US
dc.identifier.urihttps://aaltodoc.aalto.fi/handle/123456789/129819
dc.identifier.urnURN:NBN:fi:aalto-202408095387
dc.language.isoenen
dc.publisherElsevier
dc.relation.ispartofseriesThe Lancet Regional Health – Europe
dc.relation.ispartofseriesVolume 43
dc.rightsopenAccessen
dc.subject.keywordAtrial fibrillationen_US
dc.subject.keywordCHADS-VAen_US
dc.subject.keywordCHADS-VAScen_US
dc.subject.keywordRisk predictionen_US
dc.subject.keywordStrokeen_US
dc.titleComparing 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) cohorten
dc.typeA1 Alkuperäisartikkeli tieteellisessä aikakauslehdessäfi
dc.type.versionpublishedVersion
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