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Background  Accurate risk stratification is considered the first and most important step in the management of patients with non-valvular atrial fibrillation (NVAF). We compared the performance of the widely used CHA 2 DS 2 -VASc and the recently developed R 2 CHADS 2  and ATRIA scores, for predicting thromboembolic (TE) event in either non-anticoagulated or anticoagulated patients with NVAF.    Methods  The non-anticoagulated cohort was comprised of 154 patients, whereas 911 patients formed the cohort of patients on vitamin-K-antagonist. The scores were computed using the criteria mentioned in their developmental cohorts. Measures of performance for the risk scores were evaluated at predicting TE event.    Results  In the non-anticoagulated cohort, 9 TE events occurred during 11 ± 2.7 months. CHA 2 DS 2 -VASc showed significant association with TE occurrence: hazard ratio (HR) = 1.58 (95 % confidence interval [95 % IC] 1.01–2.46), but R 2 CHADS 2  and ATRIA did not (HR = 1.23 (95 % CI 0.86–1.77) and 1.20 (95 % CI 0.93–1.56), respectively.  In the anticoagulated cohort, after 10 ± 3 months of follow up, 18 TE events were developed. In that cohort, the three scores showed similar association with TE risk: HR = 1.49 (95 % CI 1.13–1.97), 1.41 (95 % CI 1.13–1.77) and 1.37 (95 % CI 1.12–1.66) for CHA 2 DS 2 -VASc, R 2 CHADS 2  and ATRIA, respectively.  In both cohorts, no TE event occurred in patients classified in the low risk category according to CHA 2 DS 2 -VASc or R 2 CHADS 2 .    Conclusions  In this study of NVAF patients, CHA 2 DS 2 -VASc has better association with TE events than the new R 2 CHADS 2  and ATRIA risk scores in the non-anticoagulated cohort. CHA 2 DS 2 -VASc and R 2 CHADS 2  can identify patients at truly low risk regardless of the anticoagulation status.

bmc cardiovascular disorders

Comparison between CHA2DS2-VASc and the new R2CHADS2 and ATRIA scores at predicting thromboembolic event in non-anticoagulated and anticoagulated patients with non-valvular atrial fibrillation