Predictive role of CHADS₂ and CHA₂DS₂-VASc scores on stroke and thromboembolism in patients without atrial fibrillation: a meta-analysis

Abstract

Objective: CHA₂DS₂-VASc is the extension of the CHADS₂ score developed by Birmingham 2009. This risk stratification schema is often used in clinical setting when considering additional risk factors for developing stroke in AF patients. However, its role in the non-AF population is unknown. This study was designed to evaluate the accuracy of the CHADS₂ and the CHA₂DS₂-VASc scoring systems.

Methods: Studies designed for CHADS₂ and CHA₂DS₂-VASc score in stratifying the risks for stroke development in non-AF patients were included.

Results: Among the 114 studies identified, six trials were chosen finally and included for meta-analysis. The pooled diagnostic odds ratio (DOR) for CHADS₂ and CHA₂DS₂-VASc was 2.86 (95% CI =1.83–4.28) and 2.80 (95% CI =1.83–4.28), respectively. CHA₂DS₂-VASc score was of better sensitivity than CHADS₂ score (0.920 vs. 0.768). However, both scores were showed to have inherent heterogeneity and poor specificity.

Conclusions: Though having good diagnostic accuracy, the clinical application of the CHADS₂ and CHA₂DS₂-VASc scores in predicting risk of stroke development in non-AF patients still needs further validation.

Key message

• The overall diagnostic accuracy of CHADS₂ and CHA₂DS₂-VASc in stroke-risk stratification was good in patients with non-atrial fibrillation.

Keywords:

• Atrial fibrillation
• CHADS2
• meta-analysis
• stroke
• thromboembolism

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Funding information

This work was financially supported by the National Natural Science Foundation of China (Nos. 81271302 and 81070914, to J. R. Liu), the ‘‘Science and Technology Project’’ of the Shanghai Pudong New Area Health Bureau (Pudong New Area Population and Family Planning Commission) (No. PW 2013D-4, to J. R. Liu), Research Innovation Project from Shanghai Municipal Science and Technology Commission (No. 14JC1404300, to J. R. Liu), Open Fund of National Key Laboratory of Medical and Neurobiology of Fudan University (No. SKLMN2014001, to J. R. Liu), and project (2015) from SHSMU-ION Research Center for Brain Disorders (to J. R. Liu), and Clinical Science and Technology Innovation Project of Shanghai Shen Kang Hospital Development Center (No. SHDC12015310, to J. R. Liu).