A Comparison Of CHA₂DS₂-VASc Score And Modified CHA₂DS₂-VASc Score For Stroke Risk In Patients From Northern China

BackgroundAs one of the most common arrhythmia,atrial fibrillation and its related stroke events seriously endanger the health of patients.Accurate prediction of stroke events is an important link in the management of patients with atrial fibrillation.Non-valvular atrial fibrillation refers to atrial fibrillation without valvular heart disease,which is an independent risk factor for stroke.In 2006,the European Heart Association（ESC）,the American Heart Association（ACC）and the American Heart Association（AHA） officially recommended the CHADS₂score for the clinical risk stratification of stroke in patients with non-valvular atrial fibrillation.Subsequently,in 2010,the European Heart Association proposed the CHA₂DS₂-VASc score,which was proved to be effective in assessing the risk of stroke in the Swedish atrial fibrillation cohort study.In 2013,the ESC AF diagnosis and treatment guidelines updated and recommended the CHA₂DS₂-VASc score.The Guidelines for the Prevention and Treatment of Stroke in China（2021 edition）recommends that the CHA₂DS₂-VASc score be used to stratify the risk of stroke in patients with non-valvular atrial fibrillation to guide antithrombotic therapy.To date,CHA₂DS₂-VASc is still the most widely used scoring system in the world.It is worth noting that the relevant studies of the CHA₂DS₂-VASc scoring system are mostly based on the characteristics of the European population and the rate of reaching the standard of anticoagulation.Although the CHA₂DS₂-VASc score has been verified in many international populations,it also has limitations.For a specific CHA₂DS₂-VASc score,the incidence of events of different races may vary greatly. Recent studies have shown that the impact of age on stroke is becoming more and more important,and the risk of stroke in Asian populations has increased exponentially since the age of 65.Therefore,Asian scholars have proposed a modified CHA₂DS₂-VASc （mCHA₂DS₂-VASc）score that is more suitable for non-valvular atrial fibrillation patients in Asian populations.Compared with the score of CHA₂DS₂-VASc,the modified version of CHA₂DS₂-VASc updated the weight of age stratification,and adjusted the weight of people over 65 years old to 2 points,and the age of 55-64 years old to 1 point.ObjectivesThe efficacy of the CHA₂DS₂-VASc score was compared with the m CHA₂DS₂-VASc score in predicting stroke risk in patients with nonvalvular atrial fibrillation.MethodsPatients from northern China with nonvalvular atrial fibrillation,hospitalized in our hospital from January 2020 to January 2021,were scored with CHA₂DS₂-VASc and m CHA₂DS₂-VASc risk scores,respectively.The patients were divided into low-,medium-,and high-risk groups according to the scores of 0,1,and≥2,respectively.The predictive value of the two scoring systems for stroke risk was compared.ResultsWe included 787 patients.Amongst them,23 patients（2.92%）in the CHA₂DS₂-VASc risk score low-risk group were higher than 8 patients（1.02%）in the m CHA₂DS₂-VASc risk score low-risk group.0 patients stroke in the CHA₂DS₂-VASc risk score low-risk group had no significant difference compared with 0 patients stroke in mCHA₂DS₂-VASc（P>0.05）;82 patients（10.42%）in CHA₂DS₂-VASc risk score medium-risk group were higher than 27 patients（3.43%）in m CHA₂DS₂-VASc risk score medium-risk group.11 patients（13.41%）with stroke in the CHA₂DS₂-VASc risk score medium-risk group had a significant difference compared with 0 patients with stroke in m CHA₂DS₂-VASc（P<0.05）;682 patients（86.66%）in CHA₂DS₂-VASc risk score high-risk group were lower than 752 patients（95.55%）in m CHA₂DS₂-VASc risk score high-risk.The stroke incidence of the two groups had no significant difference[214 patients（31.38%）VS 225 patients（29.92%）,P>0.05].ConclusionsThe mCHA₂DS₂-VASc score has better predictive value than the CHA₂DS₂-VASc score for the development of ischaemic stroke.The m CHA₂DS₂-VASc score is useful for further identification of stroke risk in people in the CHA₂DS₂-VASc score intermediate risk group.There is further clinical guidance on whether to initiate anticoagulation in the CHA₂DS₂-VASc score intermediate-risk group,especially in those who are unable to anticoagulate for various reasons such as combined high bleeding risk,anticoagulant intolerance and poor compliance.