Evidence map›Paper›PMID 41082160›Full record

Observational studyActa neurologica Belgica2025

Clinical implications of the recalibrated CHA₂DS₂-VA score for women after ischemic stroke: a prospective cohort study.

Priyanka Boettger, Jamschid Sedighi, Kerstin Piayda, Martin Juenemann, Omar Alhaj Omar, Bernhard Unsoeld, Samuel Sossalla, Michael Buerke

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Acta neurologica Belgica, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Priyanka BoettgerDepartment of Cardiology, Angiology and Critical Care Medicine, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany. Priyanka.boettger@uni-giessen.de.ORCID http://orcid.org/0009-0004-0534-132X
Jamschid SedighiDepartment of Cardiology, Angiology and Critical Care Medicine, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany.
Kerstin PiaydaDepartment of Cardiology, Angiology and Critical Care Medicine, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany.
Martin JuenemannDepartment of Neurology and Neurological Intensive Care, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany.
Omar Alhaj OmarDepartment of Neurology and Neurological Intensive Care, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany.
Bernhard UnsoeldDepartment of Cardiology, Angiology and Critical Care Medicine, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany.
Samuel SossallaDepartment of Cardiology, Angiology and Critical Care Medicine, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany.
Michael BuerkeSt. Marien Hospital, Department of Cardiology, Angiology and Critical Care Medicine, Kampenstrasse 51, Siegen, Nordrhein Westfalen, 57072, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionThe 2024 ESC atrial fibrillation guidelines introduced the CHA₂DS₂-VA score by removing female sex as an independent risk criterion. Although intended to simplify risk stratification and avoid sex-based overtreatment, the real-world implications for women who present with AF-related ischemic stroke/TIA remain unclear. In this prospective observational study, we examined the clinical implications of CHA₂DS₂-VA recalibration in a post-stroke setting, focusing on sex-specific differences in stroke severity and early functional outcome, and on the proportion of women who newly fall below the anticoagulation threshold (score ≤ 1).

methodsIn a prospective cohort of 714 consecutive stroke patients, 161 (22.5%) had documented AF. Risk stratification was performed using both CHA₂DS₂-VASc and the revised CHA₂DS₂-VA score. Stroke severity (NIHSS) and functional outcome (mRS) were analyzed by sex. Propensity score matching and multivariable logistic regression were used to examine the independent association between sex and stroke severity.

resultsFemale patients with AF were older and had a higher vascular risk burden than men. They presented with significantly more severe strokes (median NIHSS 12 vs. 8; P < 0.01) and tended toward worse outcomes. After score recalibration, 11 of 81 women (13.6%) had a CHA₂DS₂-VA score ≤ 1, falling below the ESC anticoagulation threshold-despite having experienced an ischemic stroke. Most of these patients had cardioembolic strokes and moderate-to-severe neurological deficits. In matched analyses, female sex remained independently associated with severe stroke (aOR 1.54, 95% CI 1.03-2.29).

conclusionIn this prospective cohort of AF-related ischemic stroke, women had greater comorbidity burden and higher stroke severity than men. A subgroup with CHA₂DS₂-VA ≤ 1 nonetheless sustained ischemic stroke, and exploratory 5-year follow-up suggested excess recurrence without anticoagulation. These findings require validation in larger cohorts.

Indexed as

Atrial FibrillationIschemic StrokeSeverity of Illness IndexAgedAged, 80 and overCohort StudiesFemaleHumansMaleMiddle AgedProspective StudiesRisk AssessmentRisk FactorsSex Factors

Identifiers

PMID41082160
PMCPMC12644188

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.