ArticleEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2024
Refining the CHA2DS2VASc risk stratification scheme: shall we drop the sex category criterion?
Article in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 1 of them a synthesis that pooled it.
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Who cites it
32 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Clinical outcomes of continuing vs. discontinuing oral anticoagulation after atrial fibrillation ablation: an updated systematic review and meta-analysis of observational studies and randomized controlled trials.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Pooled it
- Women with persistent atrial fibrillation need more than pulmonary vein isolation: personalised extra-pulmonary vein ablation strategy vs. pulmonary vein isolation alone in the TAILORED-AF trial.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Trial
- Risks of discontinuation of anticoagulation after atrial fibrillation ablation in high-risk patients.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Article
- Sex and gender classification in clinical decision-support tools: a cross-sectional review of tools on MDCalc.Biology of sex differences · 2026Review
- Diversity, equity, and inclusion in arrhythmia care: a European Heart Rhythm Association survey.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Article
- Female sex-related stroke risk in patients with atrial flutter-comparison between CHA2DS2-VA and CHA2DS2-VASc scores.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Article
- Adverse events after catheter ablation of atrial fibrillation: a comprehensive nationwide cohort study.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026Article
- Prognostic Impact of New-Onset Atrial Fibrillation After Cardiac Arrest: Observations From a Federated Research Network.Journal of cardiovascular electrophysiology · 2026Observational
- The Brain-Atrial Fibrillation-Recent Rehabilitation Axis: A Modern Approach.Healthcare (Basel, Switzerland) · 2026Review
- Application of Artificial Intelligence in the Early Detection and Management of Atrial Fibrillation: State-of-the-art Review.European cardiology · 2026Review
- CHAFrontiers in cardiovascular medicine · 2026Article
- Factors associated with oral anticoagulant non-use at first ischemic stroke in atrial fibrillation: A nationwide study.European stroke journal · 2026Article
- Sex differences in the initiation of antithrombotic therapy in patients with atrial fibrillation in Germany.Clinical research in cardiology : official journal of the German Cardiac Society · 2025Article
- The association between whole blood viscosity and CHA2DS2-VASc/CHA2DS2-VA scores in patients with atrial fibrillation.Future science OA · 2025Article
- External validation of CLOTS-AF score in patients with atrial fibrillation undergoing transesophageal echocardiography.Annals of medicine · 2025Article
- Clinical implications of the recalibrated CHA₂DS₂-VA score for women after ischemic stroke: a prospective cohort study.Acta neurologica Belgica · 2025Observational
- How much does elective cardioversion increase the risk of ischaemic stroke compared to the baseline risk in atrial fibrillation? A nationwide study.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Article
- Umbrella review of anticoagulation strategies for secondary prevention of cardioembolic stroke in atrial fibrillation: efficacy, safety, and knowledge gaps.Annals of medicine and surgery (2012) · 2025Review
- Asia Pacific Heart Rhythm Society (APHRS) scientific statement on stroke prevention strategies in patients with device-detected atrial fibrillation: the 4S-DDAF approach.The Lancet regional health. Western Pacific · 2025Review
- Timing of stroke risk reassessment in atrial fibrillation patients with a CHA2DS2-VA score of 0 or 1: the Norwegian AFNOR study.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Article
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5 authors.
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Abstract
aimsThe CHA2DS2VASc score is recommended for stroke risk stratification in patients with atrial fibrillation (AF). This score assigns one extra point to female sex based on evidence from the early 2000s, suggesting higher thromboembolic risk in women. This incremental risk of thromboembolism in women has decreased over time between 2007 and 2018, becoming non-significant in recent years. The objective of this study was to assess the impact of removing the sex category (Sc) from the CHA2DS2VASc score, thus validating a non-sex CHA2DS2VASc (i.e. CHA2DS2VA) score. METHODS AND
resultsWe analysed UK primary and secondary care data comprising 195 719 patients with AF followed between 1998 and 2016 (mean age: 75.9 ± 12.3 years; 49.2% women). Among 126 428 non-anticoagulated patients, we compared the CHA2DS2VASc vs. CHA2DS2VA scores every calendar year. Throughout 413 007 patient-years, a total of 8742 events of ischaemic stroke or systemic embolism were recorded. Sex differences in thromboembolic risk were not observed in the lower-risk population, but higher stroke rates were consistently seen in female patients in the higher-risk category (i.e. CHA2DS2VA ≥2). C-statistics for both CHA2DS2VA and CHA2DS2VASc scores were similar over the years (ranging from 0.62 to 0.71). With CHA2DS2VA, no relevant differences were observed in integrated discrimination improvement, and net reclassification improvement (NRI) resulted in improved reclassification (11%) in lower thromboembolic risk groups. The NRI suggested misclassification in higher thromboembolic risk patients (-7%), but this did not affect their indication for anticoagulation (i.e. patients retained their high-risk status).
conclusionRemoving Sc from the CHA2DS2VASc score does not affect its ability to discriminate thromboembolic events in the population with AF. The use of CHA2DS2VA may simplify initial decision-making for thromboprophylaxis.
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