title: Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: nationwide cohort study.
abstract: OBJECTIVE
  To evaluate the individual risk factors composing the CHADS(2) (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes, previous Stroke) score and the CHA(2)DS(2)-VASc (CHA(2)DS(2)-Vascular disease, Age 65-74 years, Sex category) score and to calculate the capability of the schemes to predict thromboembolism.
  
  
  METHODS
  Registry based cohort study.
  
  
  METHODS
  Nationwide data on patients admitted to hospital with atrial fibrillation. Population All patients with atrial fibrillation not treated with vitamin K antagonists in Denmark in the period 1997-2006.
  
  
  METHODS
  Stroke and thromboembolism.
  
  
  RESULTS
  Of 121,280 patients with non-valvular atrial fibrillation, 73,538 (60.6%) fulfilled the study inclusion criteria. In patients at "low risk" (score = 0), the rate of thromboembolism per 100 person years was 1.67 (95% confidence interval 1.47 to 1.89) with CHADS(2) and 0.78 (0.58 to 1.04) with CHA(2)DS(2)-VASc at one year's follow-up. In patients at "intermediate risk" (score = 1), this rate was 4.75 (4.45 to 5.07) with CHADS(2) and 2.01 (1.70 to 2.36) with CHA(2)DS(2)-VASc. The rate of thromboembolism depended on the individual risk factors composing the scores, and both schemes underestimated the risk associated with previous thromboembolic events. When patients were categorised into low, intermediate, and high risk groups, C statistics at 10 years' follow-up were 0.812 (0.796 to 0.827) with CHADS(2) and 0.888 (0.875 to 0.900) with CHA(2)DS(2)-VASc.
  
  
  CONCLUSIONS
  The risk associated with a specific risk stratification score depended on the risk factors composing the score. CHA(2)DS(2)-VASc performed better than CHADS(2) in predicting patients at high risk, and those categorised as low risk by CHA(2)DS(2)-VASc were truly at low risk for thromboembolism.
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, 2900 Hellerup, Denmark. jo@heart.dk
authors.forename: Jonas Bjerring
authors.initials: JB
authors.lastname: Olesen
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.forename: Morten Lock
authors.initials: ML
authors.lastname: Hansen
authors.forename: Peter Riis
authors.initials: PR
authors.lastname: Hansen
authors.forename: Janne Schurmann
authors.initials: JS
authors.lastname: Tolstrup
authors.forename: Jesper
authors.initials: J
authors.lastname: Lindhardsen
authors.forename: Christian
authors.initials: C
authors.lastname: Selmer
authors.forename: Ole
authors.initials: O
authors.lastname: Ahlehoff
authors.forename: Anne-Marie Schjerning
authors.initials: AM
authors.lastname: Olsen
authors.forename: Gunnar Hilmar
authors.initials: GH
authors.lastname: Gislason
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000401:mortality; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D018570:Risk Assessment / Q000592:standards; D020521:Stroke / Q000209:etiology* / Q000401:mortality; D013923:Thromboembolism / Q000209:etiology* / Q000401:mortality; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D014812:Vitamin K