Stroke risk stratifications according to CHA₂DS₂-VASc vs. CHA₂DS₂-VA in patients with atrial fibrillation: insights from the GLORIA-AF registry

Whether the adoption of CHA₂DS₂-VA score, the sex-independent version of the CHA₂DS₂-VASc score is beneficial for stratifying risk of stroke in patients with atrial fibrillation (AF) remains controversial.

Utilizing the data from the global, multicentre and prospective GLORIA-AF Registry Phase III, we compared the performances of CHA₂DS₂-VA and CHA₂DS₂-VASc scores in stratifying the risk of ischaemic stroke and thromboembolism (TE), and compared the risk of ischaemic stroke and TE, and the use of oral anticoagulants in male and female patients with AF. A total of 21 260 AF patients with available data were included in the analysis (mean age 70.2 ± 10.3 years, 44.9% female). Overall, female patients were less likely prescribed with oral anticoagulant (OAC) compared with males [odds ratio: 0.90, 95%confidence interval [CI]: (0.83–0.97)]. A significant interaction (P < 0.001) between sex and age was observed, with a lower likelihood of receiving OAC among younger female patients.

The risk of ischaemic stroke [hazard ratio (HR):1.14, 95%CI: (0.85–1.53)] and TE [HR: 1.02, 95%CI: (0.82–1.26)] was similar between male and female patients, and the predictive ability of the two scores was similar for both outcomes: TE [area under the receiver operating characteristic curve (AUC): 0.641, 95%CI: (0.585–0.697) vs. AUC: 0.636, 95%CI: (0.580–0.692); P = 0.593] and ischaemic stroke [AUC: 0.660, (95%CI: 0.582–0.739) vs. AUC: 0.646, (95%CI: 0.568–0.725); P = 0.847]. There was a possible interaction between sex and age observed, with a higher risk of TE in younger female patients (P = 0.051).

CHA2DS2-VA score had similar predictive performance for thromboembolic events compared with CHA₂DS₂-VASc score. The role of female sex in the management and outcomes of patients with AF may differ according to age. Whether the omission of the female criterion from CHA₂DS₂-VA would lead to less OAC use in female AF patients over the next years remains to be seen.