Validation of CHA2DS2 VASc Score Predictability of Stroke and Systemic Embolization in a Middle Eastern Population with AF: The Jordan Atrial Fibrillation (JoFib) Study

Abstract

Background and Purpose

CHA2DS2-VASc score is one of the most widely used scoring systems to assess the risk of systemic embolization and stroke in patients suffering from atrial fibrillation (Afib); furthermore, it is important in guiding their treatment. This study aimed to evaluate the predictivity of this score in the Jordanian population, build a deeper understanding of patients’ demographic and risk factors, and assess the usefulness of anticoagulation as a preventive measure.

Methods

A total of 2020 patients with Afib registered in the Jordanian Atrial Fibrillation (JoFib) registry were enrolled in this study. All patients were followed up for 1 year to assess their susceptibility to develop cerebrovascular accident (CVA) and systemic embolism (SE). The association between CHA2DS2-VASc score and risk of development of stroke or systemic embolization was analyzed based on bivariate and adjusted multivariate analyses. The ROC curve was used to assess the predictivity of the CHA2DS2-VASc score.

Results

The mean age of the study population was 67.8 years; 45.8% were males, and 81.8% were on anticoagulants. And, 71.8% had a CHA2DS2-VASc score of ≥3. During the follow-up period of 1 year; 69 developed new CVA (mean age, 72.8 years), and 9 developed SE. A total of 276 patients died; 18 patients died (6.5% out of all deceased)% from CVA. A moderate predictive power of the CHA2DS2-VASc score was demonstrated through ROC curve analysis with C statistics of 0.689 CI (0.634 to 0.744) for predicting the development of SE or CVA at 1 year.

Conclusion

CHA2DS2-VASc showed a moderate predictivity of stroke, SE, and all-cause mortality at 1 year. The study suggested disregarding gender differences in deciding to initiate anticoagulant therapy.

Keywords:

• atrial fibrillation
• Jordan
• CHA2DS2-VASc
• stroke
• risk

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

Ethics Approval and Consent to Participate

This study has been conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. This study protocol was reviewed and approved by the Medical Research Ethical Committee and the Institutional Review Board (IRB) at the University of Jordan, approval number 10/2021/415. In addition, it has been approved by all Institutional Review Board (IRB) of participating centers, for more information please refer to http://clinicatrials.gov (unique identifier number NCT03917992). Written informed consent was obtained from the patients prior to study commencement.

Acknowledgement

The authors would like to thank the participating physicians who enrolled patients for the study (in alphabetical order): Abdallah Al-Kasasbeh, AbdelrahmanObiedat, Abdullah Bani-Melhim, Abdul Nasser Almohamed, Ahmad Abdelsattar, Ahmad Abu Awwad, Ahmad Sbaih, Ahmad Tamari, AlaaAbabneh, Alanoud Hamada, Alia Khamis, Ali Abu-Romman, Ali Shakhatreh, Amer Asia, Amin Ibdah, AmrAdas, AssemNammas, AwsMukhtar, AyadAl Qudsi, Basil Abdeen, Dalia Rawashdeh, EidAbu- Eid, Eyadeh Madanat, Fahd Al-Karmi, Farah Al-Sayyed, Farah Halaweh, Fatima Al Nadi, Hana Al- Raie, HaneenShawer, HaninSaleh, Hanna Makhamreh, HazemAbu Asbeh, HishamAmin, Ibrahim Abbadi, Ibrahim Jarrad, Islam Abu Sedo, Islam Obeidat, Ismail Hamam, Kais Bilbeisi, Lama Khader, LeenSharqawi, Liza Shaban, LubabaQabbaa, LubnaHaikal, LubabaQabbaah, Mahmoud Izraiq, Marwan Nemri, Marwan Al Sultan, Mo’athAlfawar’a, Mohammad Abdah, Mohammad Afeef, Mohammad Al-Jawabreh, Mohammad Ali Jarrah, Mohammad Hani, Mohammad Kraishan, MohannadAbabneh, MohamadJarrah, Mohammad Jabary, MunirZaqqa, Mustafa Jammal, MyassarAmr, Noor Al-Badaineh, Obada Mansour, OdaiKhasawneh, OdayAbu Ajameyyeh, Omar Abu Slieh, Omar Obeidat, Omar Salaymeh, OmranAbukhalaf, Osama Oudeh, QusaiAbu Ajameyyeh, RaedAwaisheh, Rami Bataineh, Rashid Abdah, Sa’ad Al-Muhaisen, Saed Al Ghamri, Safa’ Amro, Said Meri, SalehGhamdi, SukainaRawashdeh, Sara Al-Thunibat, Sara Younis, Sharif Adwan, SulafaSaffarini, Tamer Salhab, TawfiqBarqawi, YahyaIsmail, Yousef Khader, ZaidDabash, Zeina Abu-Orabi, ZainabSalahat, ZainahMatani, ZakariaShkoukani, and Zakariya Al-Hasanat.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests.

Additional information

Funding

No funding or sponsorship was received for this report or publication of this article.