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Reiffel - Atrial Fibrillation and Stroke: Epidemiology - Figure 29

CHADS2 vs CHA2DS2-VASc

The Figure shows the conclusions of a recent study from Denmark featuring a direct comparison of the CHADS2 and CHA2DS2-VASc scoring systems, using a nationwide registry of patients admitted to the hospital with AFib who were not anticoagulated. [48] The registry totaled almost 75,000 patients and represents the largest real world cohort ever investigated. 
The main outcome measured was stroke and systemic embolism.  In patients with a score of 0 by either score, the event rate per 100 patient-years was 1.67 with CHADS2 versus 0.78 with CHA2DS2-VASc.  In patients with a score of 1, the event rate per 100 patient-years was 4.75 with CHADS2 and 2.01 with CHA2DS2-VASc.  
The important point to remember is that for a female age 66 with an MI, the score will be 3 according to CHA2DS2-VASc and 0 in CHADS2.  This illustrates why the lower scores in CHA2DS2-VASc are associated with a better accuracy of low risk – because more patients who are classified as low-to- intermediate risk by CHADS2 are actually at risk, whereas their risk is more accurately classified by CHA2DS2-VASc.  

Reiffel JA. Am J Med 2013; 126: 00-00.

Complete references for all slides

References

[48] Olesen JB, Lip GY, Hansen ML, et al. Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: nationwide cohort study. BMJ. 2011;342:d124. doi: 10.1136/bmj.d124.

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