{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T11:06:08Z","timestamp":1788519968828,"version":"build-2803163510"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2016,10]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose\u2014<\/jats:title>\n            <jats:p>\n              The age threshold for an increased stroke risk for patients with atrial fibrillation may be different for Asians and non-Asians. We hypothesized that a modified CHA\n              <jats:sub>2<\/jats:sub>\n              DS\n              <jats:sub>2<\/jats:sub>\n              -VASc (congestive heart failure, hypertension, age \u226575, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65\u201374 years, female) scheme, mCHA\n              <jats:sub>2<\/jats:sub>\n              DS\n              <jats:sub>2<\/jats:sub>\n              -VASc, which assigned one point for patients aged 50 to 74 years, may perform better than CHA\n              <jats:sub>2<\/jats:sub>\n              DS\n              <jats:sub>2<\/jats:sub>\n              -VASc score for stroke risk stratification in Asians.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods\u2014<\/jats:title>\n            <jats:p>\n              This study used the Taiwan National Health Insurance Research Database, which included 224\u2009866 newly diagnosed atrial fibrillation patients. The predictive accuracies of ischemic stroke of CHA\n              <jats:sub>2<\/jats:sub>\n              DS\n              <jats:sub>2<\/jats:sub>\n              -VASc and mCHA\n              <jats:sub>2<\/jats:sub>\n              DS\n              <jats:sub>2<\/jats:sub>\n              -VASc scores were compared among 124\u2009271 patients without antithrombotic therapies. From the whole cohort, 15\u2009948 patients had a CHA\n              <jats:sub>2<\/jats:sub>\n              DS\n              <jats:sub>2<\/jats:sub>\n              -VASc score 0 (males) or 1 (females), and 8654 patients had an mCHA\n              <jats:sub>2<\/jats:sub>\n              DS\n              <jats:sub>2<\/jats:sub>\n              -VASc score 1 (males) or 2 (females). The latter were categorized into 3 groups, that is, no treatment, antiplatelet therapy, and warfarin, and the risks of ischemic stroke and intracranial hemorrhage (ICH) were compared.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results\u2014<\/jats:title>\n            <jats:p>\n              During a follow-up of 538\u2009653 person-years, 21\u2009008 patients experienced ischemic stroke. The mCHA\n              <jats:sub>2<\/jats:sub>\n              DS\n              <jats:sub>2<\/jats:sub>\n              -VASc performed better than CHA\n              <jats:sub>2<\/jats:sub>\n              DS\n              <jats:sub>2<\/jats:sub>\n              -VASc score in predicting ischemic stroke assessed by C indexes and net reclassification index. For 8654 patients having an mCHA\n              <jats:sub>2<\/jats:sub>\n              DS\n              <jats:sub>2<\/jats:sub>\n              -VASc score of 1 (males) or 2 (females) because of the resetting of the age threshold, use of warfarin was associated with a 30% lower risk of ischemic stroke and a similar risk of ICH compared with nontreatment. Net clinical benefit analyses also favored the use of warfarin in different weighted models.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>\n              In this Asian atrial fibrillation cohort, the mCHA\n              <jats:sub>2<\/jats:sub>\n              DS\n              <jats:sub>2<\/jats:sub>\n              -VASc score performed better than the CHA\n              <jats:sub>2<\/jats:sub>\n              DS\n              <jats:sub>2<\/jats:sub>\n              -VASc and would further identify atrial fibrillation patients who may derive a positive net clinical benefit from oral anticoagulation.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.116.013880","type":"journal-article","created":{"date-parts":[[2016,9,14]],"date-time":"2016-09-14T02:49:40Z","timestamp":1473821380000},"page":"2462-2469","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":96,"title":["Validation of a Modified CHA\n            <sub>2<\/sub>\n            DS\n            <sub>2<\/sub>\n            -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation"],"prefix":"10.1161","volume":"47","author":[{"given":"Tze-Fan","family":"Chao","sequence":"first","affiliation":[{"name":"From the Division of Cardiology, Department of Medicine (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.), Division of Hematology and Oncology, Department of Medicine (C.-J.L.), Division of Infectious Diseases, Department of Medicine (S.-J.C.), Department of Family Medicine (T.-J.C.), General Clinical Research Center (C.-E.C.), and Department of Medical Research and Education (C.-E.C.), Taipei Veterans General Hospital, Taiwan; Institute of Clinical Medicine and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory Y.H.","family":"Lip","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Department of Medicine (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.), Division of Hematology and Oncology, Department of Medicine (C.-J.L.), Division of Infectious Diseases, Department of Medicine (S.-J.C.), Department of Family Medicine (T.-J.C.), General Clinical Research Center (C.-E.C.), and Department of Medical Research and Education (C.-E.C.), Taipei Veterans General Hospital, Taiwan; Institute of Clinical Medicine and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia-Jen","family":"Liu","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Department of Medicine (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.), Division of Hematology and Oncology, Department of Medicine (C.-J.L.), Division of Infectious Diseases, Department of Medicine (S.-J.C.), Department of Family Medicine (T.-J.C.), General Clinical Research Center (C.-E.C.), and Department of Medical Research and Education (C.-E.C.), Taipei Veterans General Hospital, Taiwan; Institute of Clinical Medicine and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ta-Chuan","family":"Tuan","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Department of Medicine (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.), Division of Hematology and Oncology, Department of Medicine (C.-J.L.), Division of Infectious Diseases, Department of Medicine (S.-J.C.), Department of Family Medicine (T.-J.C.), General Clinical Research Center (C.-E.C.), and Department of Medical Research and Education (C.-E.C.), Taipei Veterans General Hospital, Taiwan; Institute of Clinical Medicine and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Su-Jung","family":"Chen","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Department of Medicine (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.), Division of Hematology and Oncology, Department of Medicine (C.-J.L.), Division of Infectious Diseases, Department of Medicine (S.-J.C.), Department of Family Medicine (T.-J.C.), General Clinical Research Center (C.-E.C.), and Department of Medical Research and Education (C.-E.C.), Taipei Veterans General Hospital, Taiwan; 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Institute of Clinical Medicine and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shih-Lin","family":"Chang","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Department of Medicine (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.), Division of Hematology and Oncology, Department of Medicine (C.-J.L.), Division of Infectious Diseases, Department of Medicine (S.-J.C.), Department of Family Medicine (T.-J.C.), General Clinical Research Center (C.-E.C.), and Department of Medical Research and Education (C.-E.C.), Taipei Veterans General Hospital, Taiwan; Institute of Clinical Medicine and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-Wei","family":"Lo","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Department of Medicine (T.-F.C., T.-C.T., K.-L.W., Y.-J.L., S.-L.C., L.-W.L., Y.-F.H., C.-E.C., S.-A.C.), Division of Hematology and Oncology, Department of Medicine (C.-J.L.), Division of Infectious Diseases, Department of Medicine (S.-J.C.), Department of Family Medicine (T.-J.C.), General Clinical Research Center (C.-E.C.), and Department of Medical Research and Education (C.-E.C.), Taipei Veterans General Hospital, Taiwan; 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