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July 18, 2026Open HeartOpen Access

ATRIA score outperforms the guideline-endorsed CHA2DS2-VA score in predicting ischemic stroke.

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Why the study?

Do existing stroke risk scores accurately identify truly low-risk patients with atrial fibrillation in an Australian population?

Population

224,451 oral anticoagulant-naïve patients with a first hospital admission for atrial fibrillation between…

Design

Cohort

Follow-up

≥12 months

Key result

The ATRIA score demonstrated the best predictive accuracy for ischemic stroke (c-statistic 0.66; 95% CI 0.66-0.67), while the guideline-endorsed CHA2DS2-VA score performed the weakest (c-statistic 0.61).

Authors

NZNicolas ZubrzyckiKHKarice HyunETErdahl Teber

Discussion

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Overview

ATRIA may better identify low-risk AF patients than CHA2DS2-VA; leaves open prospective validation before changing practice.

Key Points

  • The study aims to evaluate the effectiveness of various stroke risk scores in identifying low-risk patients with atrial fibrillation in Australia.
  • Conducted a population-based cohort study using linked data from multiple databases in New South Wales, Australia.
  • Included oral anticoagulant-naïve patients with a first hospital admission for atrial fibrillation between July 2003 and January 2021.
  • Assessed predictive accuracy using concordance statistics after classifying patients into risk categories.
  • Among 224,451 eligible patients, 3,552 (1.6%) were hospitalized for ischaemic stroke within 12 months.
  • Proportion labeled low-risk ranged from 2.0% (Modified-CHADS 2) to 50.9% (ATRIA), with CHA2DS2-VASc showing the lowest discrimination (0.61).
  • Intermediate-risk patients using CHA2DS2-VASc exhibited stroke incidence below treatment thresholds.

Study Design

Type

Cohort (n=224,451)

Multicenter

Yes

Structured PICO

Do existing stroke risk scores accurately identify truly low-risk patients with atrial fibrillation in an Australian population?

P
Population
224,451 oral anticoagulant-naïve patients with a first hospital admission for atrial fibrillation in Australia, followed for ≥12 months.
E
Exposure
Stroke risk scores (CHADS2, CHA2DS2-VA, ATRIA, and Modified-CHADS2)
O
Outcome
Predictive accuracy for ischaemic stroke within 12 months (assessed using the concordance-statistic)hard clinical

Main Result

Effect estimate: c-statistic 0.66 (ATRIA) and 0.61 (CHA2DS2-VA) (95% CI 0.66-0.67 (ATRIA) and 0.60-0.61 (CHA2DS2-VA))

The guideline-endorsed CHA2DS2-VA score showed the lowest discrimination for identifying low-risk AF patients, highlighting the need for locally validated risk tools.

Cite This Study

Zubrzycki et al. (2026) conducted a cohort in Atrial fibrillation (n=224,451). Stroke risk scores (CHA2DS2-VA, CHADS2, ATRIA, Modified-CHADS2) was evaluated on Predictive accuracy for ischaemic stroke within 12 months (concordance-statistic) (c-statistic 0.66 (ATRIA) and 0.61 (CHA2DS2-VA), 95% CI 0.66-0.67 (ATRIA) and 0.60-0.61 (CHA2DS2-VA)). The ATRIA score demonstrated the best predictive accuracy for ischemic stroke (c-statistic 0.66; 95% CI 0.66-0.67), while the guideline-endorsed CHA2DS2-VA score performed the weakest (c-statistic 0.61).

synapsesocial.com/papers/6a5b38f68167787360d24e84https://doi.org/10.1136/openhrt-2026-004232
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