Extract

Background: The CHA2DS2VASc score is used to evaluate the risk of thromboembolic events in patients with non-valvular atrial fibrillation (AF). However, its usefulness to predict risk of incident AF in the general population is unknown.

Purpose: To determine whether the CHA2DS2VASc score predicts incident AF.

Methods: We analysed a population-based prospective cohort of 22,179 middle-aged individuals (mean age 57±7 years; men 39%) without prevalent AF. We grouped the population into five strata according to CHA2DS2VASc score (adjusted for sex): CHA2DS2VASc=0, CHA2DS2VASc=1, CHA2DS2VASc=2, CHA2DS2VASc=3, and CHA2DS2VASc≥4, and compared annual AF rate amongst different strata.

Results: During a median follow-up of 15 years, we observed 3094 (13.9%) new AF cases and an absolute annual incidence of 1.0% (0.99–1.07)/year. The cumulative incidence of AF was greater with increasing sex-adjusted CHA2DS2VASc strata (Figure), with an absolute annual incidence >2%/year with CHA2DS2VASc≥4. Overall, CHA2DS2VASc had acceptable discrimination performance (C-statistic=0.68) for predicting new-onset AF. In multivariate Cox regression analyses CHA2DS2VASc≥2 was an independent predictor of incident AF, regardless of age at event, hyperlipidaemia, smoking status and antithrombotic therapy.

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