{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:53:45Z","timestamp":1791356025308,"version":"4.3.1"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,10,6]]},"abstract":"\n Background<\/jats:title>\n \n To evaluate whether artificial intelligence\u2013derived electrocardiographic\u2010age enhances the predictive utility of the CHA\n 2<\/jats:sub>\n DS\n 2<\/jats:sub>\n \u2010VA (congestive heart failure\/left ventricular dysfunction, hypertension, age \u226575\u2009years [doubled], diabetes, stroke\/transient ischemic attack [doubled], vascular disease, age 65\u201374\u2009years) score in patients with atrial fibrillation representing a borderline indication for anticoagulation with a score of 1.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n From a multicenter atrial fibrillation and atrial flutter registry, we identified 832 anticoagulation\u2010na\u00efve patients with a CHA\n 2<\/jats:sub>\n DS\n 2<\/jats:sub>\n \u2010VA score of 1 and at least one 12\u2010lead ECG within 90\u2009days of diagnosis. ECG\u2010age was estimated using a previously validated deep learning (convolutional neural network) model. Chronological age was replaced with ECG\u2010age (1 point for 65\u201374\u2009years, 2 points for \u226575\u2009years), leaving all other score components unchanged, to form the EA\u2010CHA\n 2<\/jats:sub>\n DS\n 2<\/jats:sub>\n \u2010VA score. Patients were grouped as EA\u2010CHA\n 2<\/jats:sub>\n DS\n 2<\/jats:sub>\n \u2010VA \u22652 (n=315) or <2 (n=517).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Compared with patients with an EA\u2010CHA\n 2<\/jats:sub>\n DS\n 2<\/jats:sub>\n \u2010VA score <2, those with an EA\u2010CHA\n 2<\/jats:sub>\n DS\n 2<\/jats:sub>\n \u2010VA score \u22652 had a significantly higher risk of ischemic stroke or transient ischemic attack (hazard ratio [HR], 1.82 [95% CI, 1.06\u20133.13];\n P<\/jats:italic>\n =0.028). All\u2010cause mortality was also significantly elevated in the EA\u2010CHA\n 2<\/jats:sub>\n DS\n 2<\/jats:sub>\n \u2010VA \u22652 group (HR, 2.22 [95% CI, 1.43\u20133.45];\n P<\/jats:italic>\n <0.001). Major bleeding did not differ significantly between groups (\n P<\/jats:italic>\n =0.386).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Substituting chronological age with artificial intelligence\u2013derived ECG\u2010age in the CHA\n 2<\/jats:sub>\n DS\n 2<\/jats:sub>\n \u2010VA score was associated with improved risk stratification in patients with atrial fibrillation with intermediate stroke risk. This refined risk stratification facilitates timely initiation of anticoagulation therapy, potentially reducing stroke and mortality. Future prospective studies are essential to integrate this artificial intelligence\u2013enhanced strategy into clinical practice.\n <\/jats:p>\n <\/jats:sec>\n \n Registration<\/jats:title>\n \n This study was registered on the Open Science Framework (URL:\n https:\/\/doi.org\/10.17605\/OSF.IO\/39BND<\/jats:ext-link>\n ; unique identifier: 10.17605\/OSF.IO\/39BND).\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.126.050723","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T11:15:16Z","timestamp":1790680516000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Artificial Intelligence\u2013Derived Electrocardiographic Age Enhances Stroke Risk Stratification in Patients With Atrial Fibrillation With a CHA\n 2<\/sub>\n DS\n 2<\/sub>\n \u2010VA Score of 1"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-5537-0440","authenticated-orcid":false,"given":"Chen\u2010Shu","family":"Wu","sequence":"first","affiliation":[{"name":"Tri\u2010Service General Hospital, National Defense Medical University","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0280-6417","authenticated-orcid":false,"given":"Po\u2010Huang","family":"Chen","sequence":"additional","affiliation":[{"name":"Tri\u2010Service General Hospital, National Defense Medical University","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4979-2921","authenticated-orcid":false,"given":"Wen\u2010Yu","family":"Lin","sequence":"additional","affiliation":[{"name":"Tri\u2010Service General Hospital, National Defense Medical University","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3817-4079","authenticated-orcid":false,"given":"Wei\u2010Ting","family":"Liu","sequence":"additional","affiliation":[{"name":"Tri\u2010Service General Hospital, National Defense Medical University","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9771-674X","authenticated-orcid":false,"given":"Po Kai","family":"Chan","sequence":"additional","affiliation":[{"name":"Tri\u2010Service General Hospital, National Defense Medical University","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsuan Yi","family":"Wu","sequence":"additional","affiliation":[{"name":"Taipei Medical University, Shuang Ho Hospital, Ministry of Health and Welfare","place":["New Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5167-8327","authenticated-orcid":false,"given":"Chin\u2010Sheng","family":"Lin","sequence":"additional","affiliation":[{"name":"Tri\u2010Service General Hospital, National Defense Medical University","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2337-2096","authenticated-orcid":false,"given":"Chin","family":"Lin","sequence":"additional","affiliation":[{"name":"National Defense Medical University","place":["Taipei, Taiwan"]},{"name":"Tri\u2010Service General Hospital, National Defense Medical University","place":["Taipei, Taiwan"]},{"name":"National Defense Medical University","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5220-7551","authenticated-orcid":false,"given":"Chiao\u2010Chin","family":"Lee","sequence":"additional","affiliation":[{"name":"Tri\u2010Service General Hospital, National Defense Medical University","place":["Taipei, Taiwan"]},{"name":"National Defense Medical University","place":["Taipei, Taiwan"]},{"name":"Cardiovascular Research Center, National Defense Medical University","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpcardiol.2023.102181"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euae298"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2024.100967"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euae281"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000001193"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2023.100797"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2024.01.284"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-024-01428-7"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-025-01727-7"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2024.02.011"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2024.09.046"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.4103\/sja.SJA_543_18"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.754909"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.4244\/eij-d-20-01155"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18073839"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.2196\/15931"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2005.01204.x"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1009638"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1107039"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1310907"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0905561"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/circoutcomes.110.958108"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2023.03.012"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad659"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2015.03.180"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt-2021-001794"}],"container-title":["Journal 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