What question did this study set out to answer?

This study aims to evaluate the incremental value of demographic modifications and atrial fibrillation type in stroke risk stratification beyond the CHA2DS2 VASc score.

July 4, 2026Cerebrovascular Diseases ExtraOpen Access

Adding AF type to CHA2DS2-VASc modestly improves ischaemic stroke or TIA discrimination by ~0.03 AUC.

Q: What is the clinical evidence from this study?

Study design: Case-Control. Population: Atrial fibrillation (n=1908). Intervention: Addition of AF type to standard CHA2DS2 VASc predictors vs. Standard CHA2DS2 VASc predictors. Primary outcome: Discrimination for ischaemic stroke or transient ischaemic attack (AUC) (ΔAUC +0.03, p=0.015).

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Why the study?

Do demographic refinements or AF type improve stroke risk discrimination beyond the CHA2DS2 VASc score in patients with atrial fibrillation?

Population

1,908 patients with atrial fibrillation from the Auckland Regional Community Stroke Study

Comparison

Addition of demographic refinements and AF type… vs Standard CHA2DS2 VASc predictors and traditional…

Design

Case-control

Key result

Addition of AF type to standard CHA2DS2 VASc predictors modestly increased discrimination for ischaemic stroke or TIA (AUC 0.71 vs 0.68; ΔAUC +0.03; p=0.015).

Authors

KMKarim Mahawish RKRita Krishnamurthi SBSuzanne Barker-Collo

Discussion

Member takes

Overview

Demographic refinements to CHA2DS2-VASc add uncertain value in multi-ethnic AF; leaves open need for prospective validation before wider adoption.

Key Points

This study aims to evaluate the incremental value of demographic modifications and atrial fibrillation type in stroke risk stratification beyond the CHA2DS2 VASc score.
Conducted a retrospective nested case-control study of patients with atrial fibrillation diagnosed before the Auckland Regional Community Stroke Study (September 2020-August 2021).
Identified ischemic stroke or transient ischemic attack cases from a population-based registry, with controls stratified by ethnicity.
Used multivariable logistic regression for analysis, comparing traditional CHA2DS2 VASc score and modifications for discrimination using area under the receiver operating characteristic curve.
Logistic regression model with standard CHA2DS2 VASc predictors showed moderate discrimination (AUC 0.68, 95% CI 0.65-0.71).
Traditional CHA2DS2 VASc score had lower discrimination (AUC 0.63, 95% CI 0.60-0.66; ΔAUC +0.05; p=0.0003).
AF type modestly increased discrimination (AUC 0.71; ΔAUC +0.03; p=0.015), especially in non-anticoagulated patients (ΔAUC +0.05).

Study Design

Type

Case-Control (n=1,908)

Structured PICO

Do demographic refinements or AF type improve stroke risk discrimination beyond the CHA2DS2 VASc score in patients with atrial fibrillation?

Population

1,908 patients with atrial fibrillation, including 300 cases with ischaemic stroke or TIA and matched controls, evaluated for stroke risk stratification.

Exposure

Addition of demographic refinements (alternative age transformations, ethnicity, exclusion of sex) and AF type to stroke risk prediction models

Comparator

Standard CHA2DS2 VASc predictors (multivariable logistic regression model) and traditional point-based CHA2DS2 VASc score

Outcome

Discrimination for ischaemic stroke or transient ischaemic attack assessed using area under the receiver operating characteristic curve (AUC)

Main Result

Effect estimate: ΔAUC +0.03

Absolute Event Rate: 0.71% vs 0.68%

p-value: p=0.015

Demographic refinements such as ethnicity do not significantly improve stroke risk prediction beyond the CHA2DS2-VASc score in atrial fibrillation, but incorporating AF type may offer modest incremental discriminatory value.

Limitations

Requires external validation before clinical implementation is considered
Hypothesis-generating findings
Requires external validation before clinical implementation

Cite This Study

Mahawish et al. (2026) conducted a case-control in Atrial fibrillation (n=1,908). Addition of AF type to standard CHA2DS2 VASc predictors vs. Standard CHA2DS2 VASc predictors was evaluated on Discrimination for ischaemic stroke or transient ischaemic attack (AUC) (ΔAUC +0.03, p=0.015). Addition of AF type to standard CHA2DS2 VASc predictors modestly increased discrimination for ischaemic stroke or TIA (AUC 0.71 vs 0.68; ΔAUC +0.03; p=0.015).

synapsesocial.com/papers/6a48a5c889561a0c2d78e3a2 https://doi.org/10.1159/000553393

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July 4, 2026Cerebrovascular Diseases ExtraOpen Access

Adding AF type to CHA2DS2-VASc modestly improves ischaemic stroke or TIA discrimination by ~0.03 AUC.

View Full Paper

Ask AI

Bookmark

Why the study?

Do demographic refinements or AF type improve stroke risk discrimination beyond the CHA2DS2 VASc score in patients with atrial fibrillation?

Population

1,908 patients with atrial fibrillation from the Auckland Regional Community Stroke Study

Comparison

Addition of demographic refinements and AF type… vs Standard CHA2DS2 VASc predictors and traditional…

Design

Case-control

Key result

Addition of AF type to standard CHA2DS2 VASc predictors modestly increased discrimination for ischaemic stroke or TIA (AUC 0.71 vs 0.68; ΔAUC +0.03; p=0.015).

Authors

KMKarim Mahawish RKRita Krishnamurthi SBSuzanne Barker-Collo

Discussion

Member takes

Overview

Demographic refinements to CHA2DS2-VASc add uncertain value in multi-ethnic AF; leaves open need for prospective validation before wider adoption.

Key Points

This study aims to evaluate the incremental value of demographic modifications and atrial fibrillation type in stroke risk stratification beyond the CHA2DS2 VASc score.
Conducted a retrospective nested case-control study of patients with atrial fibrillation diagnosed before the Auckland Regional Community Stroke Study (September 2020-August 2021).
Identified ischemic stroke or transient ischemic attack cases from a population-based registry, with controls stratified by ethnicity.
Used multivariable logistic regression for analysis, comparing traditional CHA2DS2 VASc score and modifications for discrimination using area under the receiver operating characteristic curve.
Logistic regression model with standard CHA2DS2 VASc predictors showed moderate discrimination (AUC 0.68, 95% CI 0.65-0.71).
Traditional CHA2DS2 VASc score had lower discrimination (AUC 0.63, 95% CI 0.60-0.66; ΔAUC +0.05; p=0.0003).
AF type modestly increased discrimination (AUC 0.71; ΔAUC +0.03; p=0.015), especially in non-anticoagulated patients (ΔAUC +0.05).

Study Design

Type

Case-Control (n=1,908)

Structured PICO

Do demographic refinements or AF type improve stroke risk discrimination beyond the CHA2DS2 VASc score in patients with atrial fibrillation?

Population

1,908 patients with atrial fibrillation, including 300 cases with ischaemic stroke or TIA and matched controls, evaluated for stroke risk stratification.

Exposure

Addition of demographic refinements (alternative age transformations, ethnicity, exclusion of sex) and AF type to stroke risk prediction models

Comparator

Standard CHA2DS2 VASc predictors (multivariable logistic regression model) and traditional point-based CHA2DS2 VASc score

Outcome

Discrimination for ischaemic stroke or transient ischaemic attack assessed using area under the receiver operating characteristic curve (AUC)

Main Result

Effect estimate: ΔAUC +0.03

Absolute Event Rate: 0.71% vs 0.68%

p-value: p=0.015

Limitations

Requires external validation before clinical implementation is considered
Hypothesis-generating findings
Requires external validation before clinical implementation

Cite This Study

synapsesocial.com/papers/6a48a5c889561a0c2d78e3a2 https://doi.org/10.1159/000553393

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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