Interaction between atrial fibrillation or flutter and the CHA2DS2-VASc score on the risk of ischemic stroke: A population-based cohort study

Mohab Basem; Kasper Bonnesen; Péter Szentkúti; Erzsébet Horváth-Puhó; Henrik Toft Sørensen; Morten Schmidt

doi:10.1016/j.ijcard.2025.133397

Interaction between atrial fibrillation or flutter and the CHA₂DS₂-VASc score on the risk of ischemic stroke: A population-based cohort study

Mohab Basem^*, Kasper Bonnesen, Péter Szentkúti, Erzsébet Horváth-Puhó, Henrik Toft Sørensen, Morten Schmidt

^*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

2 Citationer (Scopus)

Abstract

Background: The CHA₂DS₂-VASc score predicts ischemic stroke risk in patients with atrial fibrillation or flutter (AF/AFL). However, it is unknown whether AF/AFL and the CHA₂DS₂-VASc score interact to increase the risk of ischemic stroke beyond their individual effects. Methods: We conducted a cohort study of all adult Danish patients with a hospital diagnosis of AF/AFL from 1996 to 2021 (n = 287,990), and a comparison cohort matched on age, sex, and CHA₂DS₂-VASc score components (n = 1,404,705). During 1-, 1–5-, and 5–10-year follow-up, we calculated ischemic stroke rates across CHA₂DS₂-VASc score categories (0, 1, 2, and ≥ 3). We also estimated the interaction effect between AF/AFL and the CHA₂DS₂-VASc score components individually. Interaction was assessed via interaction contrasts. Results: During the 1-year follow-up, the ischemic stroke rate per 1000 person-years in individuals with a CHA₂DS₂-VASc score of 0 was 5.47 in the AF/AFL cohort and 2.11 in the comparison cohort. For persons with a CHA₂DS₂-VASc score of 1, the rate was 10.19 in the AF/AFL cohort and 5.76 in the comparison cohort. The corresponding interaction contrast of 1.07 ([10.19–5.47]–[5.76–2.11]) suggested that 11 % of the ischemic stroke rate was due to interaction. Another interaction was observed between AF/AFL and a CHA₂DS₂-VASc score ≥ 3 during 5–10-year follow-up (6 %). No other interactions were observed, except for female sex, which showed a large interaction effect in all follow-up periods. Conclusion: AF/AFL and the CHA₂DS₂-VASc score interacted to increase ischemic stroke rate beyond their individual effects. Among individual CHA₂DS₂-VASc score components, female sex was associated with the largest interaction effect.

Originalsprog	Engelsk
Artikelnummer	133397
Tidsskrift	International Journal of Cardiology
Vol/bind	435
ISSN	0167-5273
DOI	https://doi.org/10.1016/j.ijcard.2025.133397
Status	Udgivet - 15 sep. 2025

Adgang til dokumentet

10.1016/j.ijcard.2025.133397Licens: CC BY

Tjek tilgængelighed hos det Kgl. Bibliotek

Andre filer og links

Link to publication in Scopus

Citationsformater

@article{cec4f7ad38b74e729015aa6f12469389,

title = "Interaction between atrial fibrillation or flutter and the CHA2DS2-VASc score on the risk of ischemic stroke: A population-based cohort study",

abstract = "Background: The CHA2DS2-VASc score predicts ischemic stroke risk in patients with atrial fibrillation or flutter (AF/AFL). However, it is unknown whether AF/AFL and the CHA2DS2-VASc score interact to increase the risk of ischemic stroke beyond their individual effects. Methods: We conducted a cohort study of all adult Danish patients with a hospital diagnosis of AF/AFL from 1996 to 2021 (n = 287,990), and a comparison cohort matched on age, sex, and CHA2DS2-VASc score components (n = 1,404,705). During 1-, 1–5-, and 5–10-year follow-up, we calculated ischemic stroke rates across CHA2DS2-VASc score categories (0, 1, 2, and ≥ 3). We also estimated the interaction effect between AF/AFL and the CHA2DS2-VASc score components individually. Interaction was assessed via interaction contrasts. Results: During the 1-year follow-up, the ischemic stroke rate per 1000 person-years in individuals with a CHA2DS2-VASc score of 0 was 5.47 in the AF/AFL cohort and 2.11 in the comparison cohort. For persons with a CHA2DS2-VASc score of 1, the rate was 10.19 in the AF/AFL cohort and 5.76 in the comparison cohort. The corresponding interaction contrast of 1.07 ([10.19–5.47]–[5.76–2.11]) suggested that 11 % of the ischemic stroke rate was due to interaction. Another interaction was observed between AF/AFL and a CHA2DS2-VASc score ≥ 3 during 5–10-year follow-up (6 %). No other interactions were observed, except for female sex, which showed a large interaction effect in all follow-up periods. Conclusion: AF/AFL and the CHA2DS2-VASc score interacted to increase ischemic stroke rate beyond their individual effects. Among individual CHA2DS2-VASc score components, female sex was associated with the largest interaction effect.",

keywords = "Atrial fibrillation, Atrial flutter, CHADS-VASc score, Comorbidity, Ischemic stroke risk",

author = "Mohab Basem and Kasper Bonnesen and P{\'e}ter Szentk{\'u}ti and Erzs{\'e}bet Horv{\'a}th-Puh{\'o} and S{\o}rensen, {Henrik Toft} and Morten Schmidt",

year = "2025",

month = sep,

day = "15",

doi = "10.1016/j.ijcard.2025.133397",

language = "English",

volume = "435",

journal = "International Journal of Cardiology",

issn = "0167-5273",

publisher = "Elsevier Ireland Ltd",

}

Interaction between atrial fibrillation or flutter and the CHA₂DS₂-VASc score on the risk of ischemic stroke: A population-based cohort study. / Basem, Mohab; Bonnesen, Kasper ; Szentkúti, Péter et al.
I: International Journal of Cardiology, Bind 435, 133397, 15.09.2025.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - Interaction between atrial fibrillation or flutter and the CHA2DS2-VASc score on the risk of ischemic stroke

T2 - A population-based cohort study

AU - Basem, Mohab

AU - Bonnesen, Kasper

AU - Szentkúti, Péter

AU - Horváth-Puhó, Erzsébet

AU - Sørensen, Henrik Toft

AU - Schmidt, Morten

PY - 2025/9/15

Y1 - 2025/9/15

N2 - Background: The CHA2DS2-VASc score predicts ischemic stroke risk in patients with atrial fibrillation or flutter (AF/AFL). However, it is unknown whether AF/AFL and the CHA2DS2-VASc score interact to increase the risk of ischemic stroke beyond their individual effects. Methods: We conducted a cohort study of all adult Danish patients with a hospital diagnosis of AF/AFL from 1996 to 2021 (n = 287,990), and a comparison cohort matched on age, sex, and CHA2DS2-VASc score components (n = 1,404,705). During 1-, 1–5-, and 5–10-year follow-up, we calculated ischemic stroke rates across CHA2DS2-VASc score categories (0, 1, 2, and ≥ 3). We also estimated the interaction effect between AF/AFL and the CHA2DS2-VASc score components individually. Interaction was assessed via interaction contrasts. Results: During the 1-year follow-up, the ischemic stroke rate per 1000 person-years in individuals with a CHA2DS2-VASc score of 0 was 5.47 in the AF/AFL cohort and 2.11 in the comparison cohort. For persons with a CHA2DS2-VASc score of 1, the rate was 10.19 in the AF/AFL cohort and 5.76 in the comparison cohort. The corresponding interaction contrast of 1.07 ([10.19–5.47]–[5.76–2.11]) suggested that 11 % of the ischemic stroke rate was due to interaction. Another interaction was observed between AF/AFL and a CHA2DS2-VASc score ≥ 3 during 5–10-year follow-up (6 %). No other interactions were observed, except for female sex, which showed a large interaction effect in all follow-up periods. Conclusion: AF/AFL and the CHA2DS2-VASc score interacted to increase ischemic stroke rate beyond their individual effects. Among individual CHA2DS2-VASc score components, female sex was associated with the largest interaction effect.

AB - Background: The CHA2DS2-VASc score predicts ischemic stroke risk in patients with atrial fibrillation or flutter (AF/AFL). However, it is unknown whether AF/AFL and the CHA2DS2-VASc score interact to increase the risk of ischemic stroke beyond their individual effects. Methods: We conducted a cohort study of all adult Danish patients with a hospital diagnosis of AF/AFL from 1996 to 2021 (n = 287,990), and a comparison cohort matched on age, sex, and CHA2DS2-VASc score components (n = 1,404,705). During 1-, 1–5-, and 5–10-year follow-up, we calculated ischemic stroke rates across CHA2DS2-VASc score categories (0, 1, 2, and ≥ 3). We also estimated the interaction effect between AF/AFL and the CHA2DS2-VASc score components individually. Interaction was assessed via interaction contrasts. Results: During the 1-year follow-up, the ischemic stroke rate per 1000 person-years in individuals with a CHA2DS2-VASc score of 0 was 5.47 in the AF/AFL cohort and 2.11 in the comparison cohort. For persons with a CHA2DS2-VASc score of 1, the rate was 10.19 in the AF/AFL cohort and 5.76 in the comparison cohort. The corresponding interaction contrast of 1.07 ([10.19–5.47]–[5.76–2.11]) suggested that 11 % of the ischemic stroke rate was due to interaction. Another interaction was observed between AF/AFL and a CHA2DS2-VASc score ≥ 3 during 5–10-year follow-up (6 %). No other interactions were observed, except for female sex, which showed a large interaction effect in all follow-up periods. Conclusion: AF/AFL and the CHA2DS2-VASc score interacted to increase ischemic stroke rate beyond their individual effects. Among individual CHA2DS2-VASc score components, female sex was associated with the largest interaction effect.

KW - Atrial fibrillation

KW - Atrial flutter

KW - CHADS-VASc score

KW - Comorbidity

KW - Ischemic stroke risk

UR - http://www.scopus.com/inward/record.url?scp=105005226411&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2025.133397

DO - 10.1016/j.ijcard.2025.133397

M3 - Journal article

C2 - 40383486

AN - SCOPUS:105005226411

SN - 0167-5273

VL - 435

JO - International Journal of Cardiology

JF - International Journal of Cardiology

M1 - 133397

ER -