Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: nationwide cohort study
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OBJECTIVES: To evaluate the individual risk factors composing the CHADS(2) (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes, previous Stroke) score and the CHA(2)DS(2)-VASc (CHA(2)DS(2)-Vascular disease, Age 65-74 years, Sex category) score and to calculate the capability of the schemes to predict thromboembolism. DESIGN: Registry based cohort study. SETTING: Nationwide data on patients admitted to hospital with atrial fibrillation. Population All patients with atrial fibrillation not treated with vitamin K antagonists in Denmark in the period 1997-2006. MAIN OUTCOME MEASURES: Stroke and thromboembolism. RESULTS: Of 121,280 patients with non-valvular atrial fibrillation, 73,538 (60.6%) fulfilled the study inclusion criteria. In patients at "low risk" (score = 0), the rate of thromboembolism per 100 person years was 1.67 (95% confidence interval 1.47 to 1.89) with CHADS(2) and 0.78 (0.58 to 1.04) with CHA(2)DS(2)-VASc at one year's follow-up. In patients at "intermediate risk" (score = 1), this rate was 4.75 (4.45 to 5.07) with CHADS(2) and 2.01 (1.70 to 2.36) with CHA(2)DS(2)-VASc. The rate of thromboembolism depended on the individual risk factors composing the scores, and both schemes underestimated the risk associated with previous thromboembolic events. When patients were categorised into low, intermediate, and high risk groups, C statistics at 10 years' follow-up were 0.812 (0.796 to 0.827) with CHADS(2) and 0.888 (0.875 to 0.900) with CHA(2)DS(2)-VASc. CONCLUSIONS: The risk associated with a specific risk stratification score depended on the risk factors composing the score. CHA(2)DS(2)-VASc performed better than CHADS(2) in predicting patients at high risk, and those categorised as low risk by CHA(2)DS(2)-VASc were truly at low risk for thromboembolism.
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In many patients with one clinical risk factor (CHA2DS2-VASc score of 1 for men, and 2 for women), anticoagulation seems to provide a clinical benefit.
“In many of these patients, anticoagulation seems to provide a clinical benefit.[371][372][373][374][375]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [371]
Rates of stroke and thromboembolism vary considerably in patients with CHA2DS2-VASc scores of 1 or 2 due to differences in outcomes, populations, and anticoagulation status.
“The rates of stroke and thromboembolism vary considerably in patients with CHA 2 DS 2 -VASc scores of 1 or 2 due to differences in outcomes, populations, and anticoagulation status (Web Addenda Table 1).371,376,377,1041”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [371]
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- Authors
- Olesen, J. B., Lip, G. Y. H., Hansen, M. L., Hansen, P. R., Tolstrup, J. S., Lindhardsen, J., Selmer, C., Ahlehoff, O., Olsen, A.-M. S., Gislason, G. H., & Torp-Pedersen, C.
- Affiliations
- Gentofte Hospital (DK)
- Birmingham City Hospital (GB)
- Danish National Institute of Public Health (DK)
- Corresponding author
- Olesen, J. B.
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2011-01-31
- Volume
- 342
- Issue
- jan31 1
- Pages
- d124-d124
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC3031123
- OpenAlex
- W2067443499
- Cited by
- 1,428
- References
- 39
- Citations by year
- 2026: 28 · 2025: 56 · 2024: 79 · 2023: 67 · 2022: 77 · 2021: 92 · 2020: 93 · 2019: 96 · 2018: 97 · 2017: 91 · 2016: 117 · 2015: 122 · 2014: 114 · 2013: 117 · 2012: 122
- FWCI
- 89.64
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Keywords
- atrial fibrillation, stroke risk, thromboembolism, risk stratification, CHADS2 score, CHA2DS2-VASc score, risk prediction, non-valvular atrial fibrillation, concordance index, risk factors, vitamin K antagonists, hospitalization, risk underestimation
- MeSH terms
- Aged, Atrial Fibrillation, Female, Hospitalization, Humans, Male, Thromboembolism, Vitamin K, Risk Assessment, Stroke, Kaplan-Meier Estimate
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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