What question did this study set out to answer?

To compare the predictive accuracy and clinical performance of the ATRIA, CHADS2, and CHA2DS2-VASc risk stratification scores for estimating stroke risk in patients with atrial fibrillation.

September 4, 2026Journal of the American College of CardiologyOpen Access

ATRIA risk score predicts ischemic stroke better than CHA2DS2-VASc with a 0.23 net reclassification improvement.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation (n=60594). Intervention: ATRIA stroke risk score vs. CHA2DS2-VASc and CHADS2 risk scores. Primary outcome: Ischemic stroke prediction (C statistic) (NRI 0.23, 95% CI 0.22 to 0.25).

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Key result

The ATRIA risk score predicted ischemic stroke better than the CHA2DS2-VASc score (C statistic 0.70 vs 0.68), with a net reclassification improvement of 0.23 (95% CI 0.22-0.25).

Authors

HHHendrika A. van den Ham OKOlaf H. Klungel DSDaniel E. Singer

Discussion

Member takes

Key expert perspectives

Captured external expert commentary on this paper, strongest first. Original sources are linked where available.

HA Hendrika A. van den HamPharmacoepidemiologist, Utrecht University

“We found that the ATRIA score more accurately identified low risk patients that the CHA2DS2-VASc score assigned to higher risk categories. Such reclassification of stroke risk could prevent overuse of anticoagulants in very low stroke risk patients with Atrial fibrillation.”

News Coverage

Overview

Informs AF anticoagulation decisions via stroke risk score choice; leaves open which tool optimizes net benefit in contemporary cohorts.

Key Points

To compare the predictive accuracy and clinical performance of the ATRIA, CHADS2, and CHA2DS2-VASc risk stratification scores for estimating stroke risk in patients with atrial fibrillation.
Evaluated stroke prediction models across patient cohorts diagnosed with atrial fibrillation.
Assessed discrimination and calibration metrics for ATRIA, CHADS2, and CHA2DS2-VASc clinical risk schemas.
Comparative risk scores demonstrate varying degrees of discrimination for predicting thromboembolic events.
Risk assessment schemas identify distinct proportions of low- and high-risk patients to guide anticoagulation therapy decisions.

Study Design

Type

Cohort (n=60,594)

Multicenter

Yes

PICO

Population

60,594 patients with atrial fibrillation not using warfarin from the U.K. Clinical Practice Research Datalink database, followed for ischemic stroke.

Exposure / Comparator

ATRIA stroke risk score vs CHA2DS2-VASc and CHADS2 risk scores

Primary Outcome

Ischemic stroke prediction (C statistic) — NRI 0.23 (0.22 to 0.25)

Main Result

Effect estimate: NRI 0.23 (95% CI 0.22 to 0.25)

Absolute Event Rate: 0.7% vs 0.68%

Cite This Study

Ham et al. (2015) conducted a cohort in Atrial fibrillation (n=60,594). ATRIA stroke risk score vs. CHA2DS2-VASc and CHADS2 risk scores was evaluated on Ischemic stroke prediction (C statistic) (NRI 0.23, 95% CI 0.22 to 0.25). The ATRIA risk score predicted ischemic stroke better than the CHA2DS2-VASc score (C statistic 0.70 vs 0.68), with a net reclassification improvement of 0.23 (95% CI 0.22-0.25).

synapsesocial.com/papers/6a9a3896eebad2e0111bf455 https://doi.org/10.1016/j.jacc.2015.08.033

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September 4, 2026Journal of the American College of CardiologyOpen Access

ATRIA risk score predicts ischemic stroke better than CHA2DS2-VASc with a 0.23 net reclassification improvement.

View Full Paper

Ask AI

Bookmark

Key result

The ATRIA risk score predicted ischemic stroke better than the CHA2DS2-VASc score (C statistic 0.70 vs 0.68), with a net reclassification improvement of 0.23 (95% CI 0.22-0.25).

Authors

HHHendrika A. van den Ham OKOlaf H. Klungel DSDaniel E. Singer

Discussion

Member takes

Key expert perspectives

Captured external expert commentary on this paper, strongest first. Original sources are linked where available.

HA Hendrika A. van den HamPharmacoepidemiologist, Utrecht University

“We found that the ATRIA score more accurately identified low risk patients that the CHA2DS2-VASc score assigned to higher risk categories. Such reclassification of stroke risk could prevent overuse of anticoagulants in very low stroke risk patients with Atrial fibrillation.”

News Coverage

Overview

Informs AF anticoagulation decisions via stroke risk score choice; leaves open which tool optimizes net benefit in contemporary cohorts.

Key Points

To compare the predictive accuracy and clinical performance of the ATRIA, CHADS2, and CHA2DS2-VASc risk stratification scores for estimating stroke risk in patients with atrial fibrillation.
Evaluated stroke prediction models across patient cohorts diagnosed with atrial fibrillation.
Assessed discrimination and calibration metrics for ATRIA, CHADS2, and CHA2DS2-VASc clinical risk schemas.
Comparative risk scores demonstrate varying degrees of discrimination for predicting thromboembolic events.
Risk assessment schemas identify distinct proportions of low- and high-risk patients to guide anticoagulation therapy decisions.

Study Design

Type

Cohort (n=60,594)

Multicenter

Yes

PICO

Population

60,594 patients with atrial fibrillation not using warfarin from the U.K. Clinical Practice Research Datalink database, followed for ischemic stroke.

Exposure / Comparator

ATRIA stroke risk score vs CHA2DS2-VASc and CHADS2 risk scores

Primary Outcome

Ischemic stroke prediction (C statistic) — NRI 0.23 (0.22 to 0.25)

Main Result

Effect estimate: NRI 0.23 (95% CI 0.22 to 0.25)

Absolute Event Rate: 0.7% vs 0.68%

Cite This Study

synapsesocial.com/papers/6a9a3896eebad2e0111bf455 https://doi.org/10.1016/j.jacc.2015.08.033

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