The CHADS₂ and CHA₂DS₂–VASc scores predict new occurrence of atrial fibrillation and ischemic stroke

Early identification of individuals who are at risk of developing atrial fibrillation (AF) and ischemic stroke may enable a closer surveillance and thus prompt initiation of oral anticoagulation for stroke prevention.

This study sought to investigate whether congestive heart failure, hypertension, age ≥ 75 years, diabetes, previous stroke (CHADS₂) and CHA₂DS₂–vascular disease, age 65–74 years, sex category (CHA₂DS₂–VASc) scores can predict new-onset AF and/or ischemic stroke in patients presenting with arrhythmic symptoms.

We prospectively followed up 528 patients (68.5 ± 10.6 years, male 46.2 %) presented for assessment of arrhythmic symptoms but without any documented arrhythmia, including AF for development of new-onset AF and/or ischemic stroke. Their mean CHADS₂ and CHA₂DS₂–VASc scores on presentation were 1.3 ± 1.3 and 2.3 ± 1.5, respectively. After 6.1 years, 89 patients (16.8 %, 2.77 per 100 patient-years) had documented AF, and 65 patients (12.3 %, 2.0 per 100 patient-years) suffered stroke. Both the CHADS₂ (C statistic 0.63, 95 % confidence interval (CI) 0.58–0.67, P < 0.0001, optimal cutoff at 1) and CHA₂DS₂–VASc (C statistic 0.63, 95 % CI 0.59–0.67, P < 0.0001, optimal cutoff at 2) scores provided similar prediction for the new-onset AF. Similarly, CHADS₂ (C statistic 0.69, 95 % CI 0.65–0.73, P < 0.0001, optimal cutoff at 2) and CHA₂DS₂–VASc (C statistic 0.69, 95 % CI 0.65–0.73, P < 0.0001, optimal cutoff at 2) have compatible efficacy for stroke prediction in this Chinese population.

The CHADS₂ and CHA₂DS₂–VASc scores can be used in patients who presented with arrhythmic symptoms to identify those who are at risk with developing new-onset clinical AF and ischemic stroke for close clinical surveillance and early intervention.