Predictive performance of the CHA2DS2‐VASc rule in atrial fibrillation: a systematic review and meta‐analysis

Abstract

Background The CHA2DS2-VASc decision rule is widely recommended for estimating stroke risk in patients with atrial fibrillation (AF), although validation studies show ambiguous and conflicting results. Objectives To: (i) review existing studies validating CHA2DS2-VASc in AF patients who are not (yet) anticoagulated; (ii) meta-analyze estimates of stroke risk per score; and (iii) explore sources of heterogeneity across the validation studies. Methods We performed a systematic literature review and random effects meta-analysis of studies externally validating CHA2DS2-VASc in AF patients not receiving anticoagulants. To explore between-study heterogeneity in stroke risk, we stratified studies to the clinical setting in which patient enrollment started, and performed meta-regression. Results In total, 19 studies were evaluated, with over two million person-years of follow-up. In studies recruiting AF patients in hospitals, stroke risks for scores of 0, 1 and 2 were 0.4% (approximate 95% prediction interval [PI] 0.2-3.2%), 1.2% (95% PI 0.1-3.8%), and 2.2% (95% PI 0.03-7.8%), respectively. These were consistently higher than those in studies recruiting patients from the open general population, with risks of 0.2% (95% PI 0.0-0.9%), 0.7% (95% PI 0.3-1.2%) and 1.5% (95% PI 0.4-3.3%) for scores of 0, 1, and 2, respectively. Heterogeneity, as reflected by the wide PIs, could not be fully explained by meta-regression. Conclusions Studies validating CHA2DS2-VASc show high heterogeneity in predicted stroke risks for different scores.

Impact of atrial fibrillation in critically ill patients admitted to a stepdown unit

“…Both CHA 2 DS 2 -VASc and HAS-BLED scores were originally developed from general AF patients' cohorts and tested on 1-year outcomes. 27,28 Notwithstanding, since then both the scores were largely validated in various cohorts and tested on variable follow-up times [29][30][31] ; indeed, the use of both the scores is currently recommended from most of the international clinical AF guidelines. 32…”

CHA2DS2-VASc Score as a Predictor for Left Atrial Thrombus or Spontaneous Echo Contrast in Patients with Nonvalvular Atrial Fibrillation: A Meta-Analysis

“…CHA 2 DS 2 -VASc is a simple, clinical risk factor-based approach to thromboprophylaxis. Although the CHA2DS 2 -VASc score has been widely used to evaluate the risk recurrence of AF [ 7 ] and ischemic stroke in patients with AF [ 8 ], there has been limited evidence of LAT/LASEC prediction according to CHA2DS2-VASc scores. In 2015, a letter to an editor [ 9 ] reported that a high CHA 2 DS 2 -VASc score can predict LAT/LASEC by analyzing six relevant studies [ 10 – 15 ].…”

Valor do Diâmetro do Átrio Esquerdo com Escore CHA2DS2-Vasc na Predição da Trombose Atrial Esquerda/Trombose de Apêndice Atrial Esquerdo na Fibrilação Atrial Não Valvar

“…O escore CHA2DS2-VASc foi estabelecido otimizando ainda mais o escore CHADS2, que é um método clínico comumente usado para avaliar o risco de acidente vascular cerebral em pacientes com FA atualmente, sendo também usado para orientar o tratamento clínico. 15 Um estudo revelou que 16 um escore CHA2DS2-VASc ≥2 é um fator de risco independente para trombose atrial esquerda/ trombose de apêndice atrial esquerdo em pacientes com FA. O presente estudo revelou que o escore CHA2DS2-VASc foi maior no grupo trombose do que no grupo não trombose.…”