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The CHA 2 DS 2 -VASc score is a validated predictor of ischemic stroke in atrial fibrillation (AF) patients. However, data are limited on whether the CHA 2 DS 2 -VASc score is associated with subclinical brain structural changes or physical frailty among older AF patients. We assessed the relationship between CHA 2 DS 2 -VASc scores and brain structural changes or physical frailty in AF patients without history of stroke. Overall, 117 patients completed a comprehensive geriatric assessment for physical frailty. In brain magnetic resonance imaging sub-study (n = 49), brain volume and white matter hyperintensity lesion burden were automatically quantified using the LESIONQUANT software program. Patients with high risk of CHA 2 DS 2 -VASc scores (≥ 2 in men or ≥ 3 in women) tended to be older and had more comorbidities, higher frailty index, and slower gait speed. Total white matter hyperintensity lesion burden was higher in those with high risk of CHA 2 DS 2 -VASc score than in those with intermediate risk (score of 1 in men or 2 in women) of CHA 2 DS 2 -VASc score (1.67 [interquartile range: 0.70–3.45] vs. 0.64 [0.19–1.44],  p  = 0.036). Cognitive function was associated with brain volume, but gait speed was related with white matter hyperintensity lesion burden. In conclusion, we showed a positive relationship between CHA 2 DS 2 -VASc scores, white matter hyperintensity lesion burden, and physical frailty in older AF patients. Subclinical brain changes associated with high CHA 2 DS 2 -VASc scores may predict physical frailty risk.

CHA2DS2-VASc score, cerebral small vessel disease, and frailty in older patients with atrial fibrillation