Abstract 17712: The Discrimination Ability of the CHA2DS2-VASc Score for Predicting Ischemic Stroke in Patients With and Without Atrial Fibrillation: An Updated Meta-Analysis

Abstract

BACKGROUND: The CHA2DS2-VASc score guides anticoagulation therapy for stroke prevention in non-valvular atrial fibrillation (NVAF) patients. A previous meta-analysis showed a moderate discrimination ability of CHA2DS2-VASc score to detect stroke in patients with & without NVAF. In the presence of newly published data over the past three years, there is a need to recalibrate the existing statistical evidence. METHODS: A comprehensive literature search was conducted across PubMed, Embase, CENTRAL (the Cochrane Library), & Google Scholar from inception till May 2023. All studies evaluating the discrimination ability of the CHA2DS2-VASc score, as measured by the C statistic, for short (<2 years), intermediate (2-5 years), & long-term (>5 years) follow-ups in patients with & without NVAF were included. The generic inverse variance weighted random effects method was used to pool C-statistic & corresponding standard errors (SEs) from each study. RESULTS: A total of 28 studies with a population of 639450 patients were included. Seventeen studies (n=500555) reported the discrimination ability of CHA2DS2-VASc score for NVAF patients, & 11 studies (n=138895) for patients without NVAF. The summary C statistic for short-term follow up was 0.66 (0.62-0.70) for NVAF subgroup. For mid-term follow-up, the pooled C statistic was 0.65 (0.63-0.67), while being 0.63 (0.60-0.66) & 0.68 (0.66-0.70) for the subgroup with NVAF & without NVAF respectively. The CHA2DS2-VASC score showed moderate discrimination [0.66 (0.62-0.70)] at long-term follow up (NVAF [0.58 (0.55-0.61)]; without NVAF [0.67 (0.64-0.70]). CONCLUSION: CHA2DS2-VASc score has moderate & similar discrimination ability for detecting stroke in both NVAF & non-NVAF patients.