{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:29:10Z","timestamp":1786123750045,"version":"build-2736575974"},"reference-count":7,"publisher":"S. Karger AG","issue":"1","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cerebrovasc Dis Extra"],"abstract":"Introduction: The CHA<sub>2<\/sub>DS<sub>2<\/sub> VASc score is widely used for stroke risk stratification in atrial fibrillation (AF). Efforts to improve prediction using demographic refinements have uncertain incremental value, particularly in multi-ethnic populations. We evaluated whether demographic modification or AF type provides additional discriminatory value. Methods: We conducted a retrospective nested case-control study of patients with AF diagnosed prior to the fifth Auckland Regional Community Stroke Study (September 2020\u2013August 2021). Cases with ischaemic stroke or transient ischaemic attack were identified from this population-based registry with central adjudication. Controls were randomly selected from the National Minimum Dataset, stratified by ethnicity. Predictors included CHA<sub>2<\/sub>DS<sub>2<\/sub> VASc components, demographic refinements (alternative age transformations, ethnicity, and exclusion of sex), and AF type. The primary baseline model was a multivariable logistic regression model using standard CHA<sub>2<\/sub>DS<sub>2<\/sub> VASc predictors as covariates. The traditional point-based CHA<sub>2<\/sub>DS<sub>2<\/sub> VASc score was evaluated separately for comparison. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC). Results: The study included 1,908 patients (300 cases). A logistic regression model using standard CHA<sub>2<\/sub>DS<sub>2<\/sub> VASc predictors demonstrated moderate discrimination {AUC 0.68 (95% confidence interval [CI]: 0.65\u20130.71)}. The traditional point-based CHA<sub>2<\/sub>DS<sub>2<\/sub> VASc score showed lower discrimination (AUC 0.63 [95% CI: 0.60\u20130.66]; \u0394AUC +0.05; p = 0.0003). Demographic refinements did not improve discrimination (\u0394AUC \u2264 0.01). Addition of AF type modestly increased discrimination (AUC 0.71; \u0394AUC +0.03; p = 0.015), with greater improvement in non-anticoagulated patients (\u0394AUC +0.05). Conclusion: Demographic refinements, including ethnicity, provide limited incremental value beyond CHA<sub>2<\/sub>DS<sub>2<\/sub> VASc, whereas AF type offers a modest discriminatory signal. This finding is hypothesis-generating and requires external validation before clinical implementation is considered.<\/jats:p>","DOI":"10.1159\/000553393","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T16:16:15Z","timestamp":1783008975000},"page":"206-211","source":"Crossref","is-referenced-by-count":0,"title":["Demographic Refinement and Atrial Fibrillation Type in Stroke Risk Stratification beyond CHA\n 2<\/sub>\n DS\n 2<\/sub>\n VASc"],"prefix":"10.1159","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2256-6470","authenticated-orcid":false,"given":"Karim M.","family":"Mahawish","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0869-2083","authenticated-orcid":false,"given":"Rita V.","family":"Krishnamurthi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"Barker-Collo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3223-3330","authenticated-orcid":false,"given":"Annamarei","family":"Ranta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derrick","family":"Bennett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene Suilen","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6372-1740","authenticated-orcid":false,"given":"Valery","family":"Feigin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harvey","family":"White","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.26635\/6965.6846"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.05.044"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1159\/000546212"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.125.045260"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanwpc.2025.101508"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2023-078378"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae176"}],"container-title":["Cerebrovascular Diseases Extra"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/000553393","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:00:58Z","timestamp":1786118458000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000553393"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,2]]},"references-count":7,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,1]]}},"URL":"https:\/\/doi.org\/10.1159\/000553393","archive":["Portico"],"relation":{},"ISSN":["1664-5456"],"issn-type":[{"value":"1664-5456","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,2]]}}}