Researchers at the Liverpool Centre for Cardiovascular Science have studied the impact of strokes caused by atrial fibrillation on women and men. Their latest findings could change clinical practice by enabling better risk assessment and stroke prevention.

The article “Comparison of CHA2DS2-VA and CHA2DS2-VASc scores for stroke risk stratification in patients with atrial fibrillation: a temporal trend analysis from the retrospective Finnish Anticoagulation in Atrial Fibrillation Cohort (FinACAF)” was published in The Lancet Regional Health Europe.

Atrial fibrillation is a common heart condition that causes an irregular and often abnormally fast heartbeat, increasing the risk of stroke fivefold. In adults, the risk of developing atrial fibrillation during their lifetime is 1 in 3, leading to a high risk of stroke, heart failure and dementia.

Previously, it was known that women were at higher risk of atrial fibrillation-related stroke. In addition, female patients with atrial fibrillation were often underdosed with oral anticoagulants – “blood thinners” prescribed to reduce blood clots and strokes. In addition, strokes caused by atrial fibrillation tended to be more severe in women than in men.

In general, the overall rate of AF-related strokes has declined in recent years, due to increased awareness and better risk factor management, as well as improved risk assessment tools such as the CHA2DS2-VASc score, which takes into account gender category (Sc, for female gender) in its calculation. In recent years, the difference in AF-related stroke rates between women and men is no longer significant, so a gender-independent CHA2DS2-VASc score (ie, CHA2DS2-VA) may simplify decision-making.

Professor Gregory Lip, Director of the Liverpool Centre for Cardiovascular Science, who led the study, said: “This powerful analysis shows that women have historically been at higher risk of atrial fibrillation-related stroke but tended to be under-prescribed with potentially life-saving blood-thinning preventive medications. Therefore, using the CHA2DS2-VASc score made sense. With more recent data, the difference between women and men in stroke risk is less clear, so a gender-independent CHA2DS2-VASc score (ie CHA2DS2-VASc) could enable simpler and more practical decision-making.”