Stroke Risk in Atrial Fibrillation: Beyond the CHA2DS2-VASc Score
Purpose of Review
Stroke prevention is the cornerstone of atrial fibrillation (AF) management and the anticoagulation decision is currently based on CHA2DS2-VASc risk score. We discuss several novel risk factors besides those included in CHA2DS2-VASc score and alternative models for stroke prediction.
Several clinical markers including obstructive sleep apnea and renal failure, laboratory markers like brain natriuretic peptide, imaging criteria including left atrial appendage morphology, spontaneous echo contrast, and coronary artery calcium score may predict stroke in AF patients. Addition of African American ethnicity to CHA2DS2-VASc score also improves stroke prediction in AF. Finally, novel models including TIMI-AF score, ATRIA score, and GARFIELD-AF scores have potential roles in risk stratification for stroke.
While CHA2DS2-VASc score is the currently recommended risk stratification model for stroke prediction in AF, use of additional clinical, laboratory, imaging markers, ethnicity, and novel stroke prediction models may further assist in decision to anticoagulate the AF patient for stroke prevention.
KeywordsStroke Atrial fibrillation Race CHA2DS2-VASc
Compliance with Ethical Standards
Conflict of Interest
Pooja S. Jagadish and Rajesh Kabra declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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