{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T11:07:00Z","timestamp":1789556820958,"version":"build-2803163510"},"reference-count":38,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"unspecified","delay-in-days":16,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Emerging Leadership 1","award":["GNT1196724"],"award-info":[{"award-number":["GNT1196724"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,7,3]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Australian guidelines recommend the CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      -VA (congestive heart failure, hypertension, age \u226575 years (double weight), diabetes mellitus, previous stroke (double weight), vascular disease, age 65\u201374 years) score to identify patients with atrial fibrillation (AF) at low stroke risk who should avoid oral anticoagulation. Treatment thresholds were derived from heterogeneous international data, and alternate scores require validation in an Australian population. We evaluated whether existing stroke scores (CHADS\n                      <jats:sub>2<\/jats:sub>\n                      (congestive heart failure, hypertension, age \u226575 years, diabetes mellitus, previous stroke (double weight)), CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      -VA, ATRIA (anticoagulation and risk factors in atrial fibrillation) and Modified-CHADS\n                      <jats:sub>2<\/jats:sub>\n                      ) accurately identify truly low-risk patients in Australia.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a population-based cohort study using linked data from the New South Wales Admitted Patient Data Collection, the National Death Index and the Pharmaceutical Benefits Scheme databases. Oral anticoagulant-na\u00efve patients with a first hospital admission for AF between July 2003 and January 2021 were included. Patients were followed for \u226512 months and classified into low-risk, intermediate-risk or high-risk categories for each score. \u2018Truly low-risk\u2019 was defined as annual ischaemic stroke incidence &lt;0.9%. Predictive accuracy was assessed using the concordance-statistic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 224\u2009451 eligible patients, 3552 (1.6%) were hospitalised for ischaemic stroke within 12\u2009months. The proportion labelled low-risk ranged from 2.0% (Modified-CHADS\n                      <jats:sub>2<\/jats:sub>\n                      ) to 50.9% (ATRIA). Patients assigned low-risk using each score, and intermediate-risk with the CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      -VA score, met the definition of truly low-risk. Concordance-statistics were modest, with the weakest performing score being the CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      -VA score (0.61, 95%\u2009CI 0.60 to 0.61)\u2009and the best performing model being the ATRIA score (0.66, 95%\u2009CI 0.66 to 0.67).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      The guideline-endorsed CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      -VA score showed the lowest discrimination, and patients classified as intermediate-risk using this score had stroke incidence below the treatment threshold. Strong consideration should be given to the development and validation of locally applicable risk tools.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2026-004232","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T11:55:15Z","timestamp":1784289315000},"page":"e004232","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative performance of stroke risk scores in patients with atrial fibrillation with low stroke risk"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0099-4119","authenticated-orcid":false,"given":"Nicolas","family":"Zubrzycki","sequence":"first","affiliation":[{"name":"St Vincent\u2019s Hospital Sydney, Darlinghurst, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0164-7725","authenticated-orcid":false,"given":"Karice","family":"Hyun","sequence":"additional","affiliation":[{"name":"The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia"},{"name":"Cardiology, ANZAC Research Institute Concord Repatriation General Hospital, Concord, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erdahl","family":"Teber","sequence":"additional","affiliation":[{"name":"The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia"},{"name":"Cardiology, ANZAC Research Institute Concord Repatriation General Hospital, Concord, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boroumand","family":"Farzaneh","sequence":"additional","affiliation":[{"name":"The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia"},{"name":"Cardiology, ANZAC Research Institute Concord Repatriation General Hospital, Concord, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Austin Chin Chwan","family":"Ng","sequence":"additional","affiliation":[{"name":"Cardiology, Concord Hospital and The University of Sydney, Concord, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Freedman","sequence":"additional","affiliation":[{"name":"Charles Perkins Centre, Heart Research Institute, University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6115-0326","authenticated-orcid":false,"given":"David B","family":"Brieger","sequence":"additional","affiliation":[{"name":"Cardiology, ANZAC Research Institute Concord Repatriation General Hospital, Concord, New South Wales, Australia"},{"name":"Cardiology, Concord Hospital and The University of Sydney, Concord, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"2026091603501980000_13.2.e004232.1","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000024000","article-title":"CHADS2, CHA2DS2-VASc, ATRIA, and Essen stroke risk scores in stroke with atrial fibrillation: A nationwide multicenter registry study","volume":"100","author":"Yu","year":"2021","journal-title":"Medicine 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