{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T01:27:15Z","timestamp":1780536435123,"version":"3.54.1"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T00:00:00Z","timestamp":1636675200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T00:00:00Z","timestamp":1636675200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100010724","name":"Health Systems Research Institute","doi-asserted-by":"crossref","award":["59-053"],"award-info":[{"award-number":["59-053"]}],"id":[{"id":"10.13039\/501100010724","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100010724","name":"Health Systems Research Institute","doi-asserted-by":"crossref","award":["59-053"],"award-info":[{"award-number":["59-053"]}],"id":[{"id":"10.13039\/501100010724","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100010724","name":"Health Systems Research Institute","doi-asserted-by":"crossref","award":["59-053"],"award-info":[{"award-number":["59-053"]}],"id":[{"id":"10.13039\/501100010724","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Heart Association of Thailand"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Cardiovasc Disord"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>There is no data specific to the addition of renal dysfunction and age 50\u201364\u00a0years as risk parameters to the CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VA score, which is known as the R<jats:sub>2<\/jats:sub>CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VA score, among NVAF patients. Accordingly, the aim of this study was to validate the R<jats:sub>2<\/jats:sub>CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VA score for predicting thromboembolism in Thai NVAF patients.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Thai NVAF patients were prospectively enrolled in a nationwide multicenter registry from 27 hospitals during 2014\u20132020. Each component of the CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VA and R<jats:sub>2<\/jats:sub>CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VA scores was scored and recorded. The main outcomes were thromboembolism, including ischemic stroke, transient ischemic attack (TIA), and\/or systemic embolism. The annual incidence rate of thromboembolism among patients in each R<jats:sub>2<\/jats:sub>CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VA and CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VA risk score category is shown as hazard ratio (HR) and 95% confidence interval (95% CI). The performance of the R<jats:sub>2<\/jats:sub>CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VA and CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VA scores was demonstrated using c-statistics. Net reclassification index was calculated. Calibration plat was used to assess agreement between observed probabilities and predicted probabilities of both scoring system.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 3402 patients were enrolled during 2014\u20132020. The average age of patients was 67.38\u2009\u00b1\u200911.27\u00a0years. Of those, 46.9% had renal disease, 30.7% had a history of heart failure, and 17.1% had previous stroke or TIA. The average R<jats:sub>2<\/jats:sub>CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VA and CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VA scores were 3.92\u2009\u00b1\u20091.92 and 2.98\u2009\u00b1\u20091.43, respectively. Annual thromboembolic risk increased with incremental increase in R<jats:sub>2<\/jats:sub>CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VA and CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VA scores. Oral anticoagulants had benefit in stroke prevention in NVAF patients with an R<jats:sub>2<\/jats:sub>CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VA score of 2 or more (adjusted HR: 0.630, 95% CI 0.413\u20130.962, <jats:italic>p<\/jats:italic>\u2009=\u20090.032). The c-statistics were 0.630 (95% CI 0.61\u20130.65) and 0.627 (95% CI 0.61\u20130.64), for R<jats:sub>2<\/jats:sub>CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VA and CHA2DS2-VA scores respectively. NRI was 2.2%. The slope and R2 of the calibration plot were 0.73 and 0.905 for R<jats:sub>2<\/jats:sub>CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VA and 0.70 and 0.846 for CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VA score respectively.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>R<jats:sub>2<\/jats:sub>CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VA score was found to be at least as good as CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VA score for predicting thromboembolism in Thai patients with NVAF. Similar to CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VA score, thromboembolism increased with incremental increase in R<jats:sub>2<\/jats:sub>CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VA score.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12872-021-02370-2","type":"journal-article","created":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T06:03:08Z","timestamp":1636696988000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Efficacy of R2CHA2DS2-VA score for predicting thromboembolism in Thai patients with non-valvular atrial fibrillation"],"prefix":"10.1186","volume":"21","author":[{"given":"Komsing","family":"Methavigul","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Poom","family":"Sairat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rungroj","family":"Krittayaphong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the COOL-AF Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,11,12]]},"reference":[{"key":"2370_CR1","doi-asserted-by":"crossref","unstructured":"Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials. Arch Intern Med 1994, 154:1449\u20131457.","DOI":"10.1001\/archinte.154.13.1449"},{"key":"2370_CR2","doi-asserted-by":"publisher","first-page":"2893","DOI":"10.1093\/eurheartj\/ehw210","volume":"37","author":"P Kirchhof","year":"2016","unstructured":"Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37:2893\u2013962.","journal-title":"Eur Heart J"},{"key":"2370_CR3","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1016\/j.chest.2018.07.040","volume":"154","author":"GYH Lip","year":"2018","unstructured":"Lip GYH, Banerjee A, Boriani G, Chiang CE, Fargo R, Freedman B, et al. Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report. Chest. 2018;154:1121\u2013201.","journal-title":"Chest"},{"key":"2370_CR4","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1016\/j.jacc.2019.01.011","volume":"74","author":"CT January","year":"2019","unstructured":"January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC Jr, et al. 2019 AHA\/ACC\/HRS Focused Update of the 2014 AHA\/ACC\/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019;74:104\u201332.","journal-title":"J Am Coll Cardiol"},{"key":"2370_CR5","doi-asserted-by":"publisher","first-page":"2204","DOI":"10.1016\/j.jacc.2019.08.1031","volume":"74","author":"S Kumar","year":"2019","unstructured":"Kumar S, Lim E, Covic A, Verhamme P, Gale CP, Camm AJ, et al. Anticoagulation in Concomitant Chronic Kidney Disease and Atrial Fibrillation: JACC Review Topic of the Week. J Am Coll Cardiol. 2019;74:2204\u201315.","journal-title":"J Am Coll Cardiol"},{"key":"2370_CR6","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1161\/CIRCULATIONAHA.112.107128","volume":"127","author":"JP Piccini","year":"2013","unstructured":"Piccini JP, Stevens SR, Chang Y, Singer DE, Lokhnygina Y, Go AS, et al. Renal dysfunction as a predictor of stroke and systemic embolism in patients with nonvalvular atrial fibrillation: validation of the R(2)CHADS(2) index in the ROCKET AF (Rivaroxaban Once-daily, oral, direct factor Xa inhibition Compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation) and ATRIA (AnTicoagulation and Risk factors In Atrial fibrillation) study cohorts. Circulation. 2013;127:224\u201332.","journal-title":"Circulation"},{"key":"2370_CR7","doi-asserted-by":"publisher","first-page":"2970","DOI":"10.1253\/circj.CJ-18-0218","volume":"82","author":"MJ Cha","year":"2018","unstructured":"Cha MJ, Cho Y, Oh IY, Choi EK, Oh S. Validation of conventional thromboembolic risk factors in a Korean atrial fibrillation population- Suggestion for a Novel Scoring System, CHA2DS2-VAK. Circ J. 2018;82:2970\u20135.","journal-title":"Circ J"},{"key":"2370_CR8","doi-asserted-by":"publisher","first-page":"2079","DOI":"10.1016\/j.jacc.2013.02.035","volume":"61","author":"A Banerjee","year":"2013","unstructured":"Banerjee A, Fauchier L, Vourc\u2019h P, Andres CR, Taillandier S, Halimi JM, et al. Renal impairment and ischemic stroke risk assessment in patients with atrial fibrillation: the Loire Valley Atrial Fibrillation Project. J Am Coll Cardiol. 2013;61:2079\u201387.","journal-title":"J Am Coll Cardiol"},{"key":"2370_CR9","doi-asserted-by":"publisher","first-page":"1339","DOI":"10.1016\/j.jacc.2015.07.026","volume":"66","author":"TF Chao","year":"2015","unstructured":"Chao TF, Wang KL, Liu CJ, Lin YJ, Chang SL, Lo LW, et al. Age threshold for increased stroke risk among patients with atrial fibrillation: a nationwide cohort study from Taiwan. J Am Coll Cardiol. 2015;66:1339\u201347.","journal-title":"J Am Coll Cardiol"},{"key":"2370_CR10","doi-asserted-by":"publisher","first-page":"1381","DOI":"10.1016\/j.cjca.2016.05.009","volume":"32","author":"PH Chan","year":"2016","unstructured":"Chan PH, Lau CP, Tse HF, Chiang CE, Siu CW. CHA2DS2-VASc Recalibration With an Additional Age Category (50\u201364 Years) Enhances Stroke Risk Stratification in Chinese Patients With Atrial Fibrillation. Can J Cardiol. 2016;32:1381\u20137.","journal-title":"Can J Cardiol"},{"key":"2370_CR11","doi-asserted-by":"publisher","first-page":"2462","DOI":"10.1161\/STROKEAHA.116.013880","volume":"47","author":"TF Chao","year":"2016","unstructured":"Chao TF, Lip GY, Liu CJ, Tuan TC, Chen SJ, Wang KL, et al. Validation of a Modified CHA2DS2-VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation: A Nationwide Cohort Study. Stroke. 2016;47:2462\u20139.","journal-title":"Stroke"},{"key":"2370_CR12","first-page":"1473","volume":"38","author":"C Renoux","year":"2017","unstructured":"Renoux C, Coulombe J, Suissa S. Revisiting sex differences in outcomes in non-valvular atrial fibrillation: a population-based cohort study. Eur Heart J. 2017;38:1473\u20139.","journal-title":"Eur Heart J"},{"key":"2370_CR13","doi-asserted-by":"publisher","first-page":"832","DOI":"10.1161\/CIRCULATIONAHA.117.029081","volume":"137","author":"PB Nielsen","year":"2018","unstructured":"Nielsen PB, Skjoth F, Overvad TF, Larsen TB, Lip GYH. Female sex is a risk modifier rather than a risk factor for stroke in atrial fibrillation: should we use a CHA2DS2-VA Score Rather Than CHA2DS2-VASc? Circulation. 2018;137:832\u201340.","journal-title":"Circulation"},{"key":"2370_CR14","doi-asserted-by":"publisher","first-page":"894","DOI":"10.1055\/s-0040-1710014","volume":"120","author":"PB Nielsen","year":"2020","unstructured":"Nielsen PB, Overvad TF. Female Sex as a Risk Modifier for Stroke Risk in Atrial Fibrillation: Using CHA2DS2-VASc versus CHA2DS2-VA for Stroke Risk Stratification in Atrial Fibrillation: A Note of Caution. Thromb Haemost. 2020;120:894\u20138.","journal-title":"Thromb Haemost"},{"key":"2370_CR15","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.2147\/CIA.S138405","volume":"12","author":"S Fu","year":"2017","unstructured":"Fu S, Zhou S, Luo L, Ye P. R2(GFR)CHADS2 and R2(GFR)CHA2DS2VASc schemes improved the performance of CHADS2 and CHA2DS2VASc scores in death risk stratification of Chinese older patients with atrial fibrillation. Clin Interv Aging. 2017;12:1233\u20138.","journal-title":"Clin Interv Aging"},{"key":"2370_CR16","doi-asserted-by":"publisher","first-page":"2160","DOI":"10.1161\/STR.0000000000000024","volume":"45","author":"WN Kernan","year":"2014","unstructured":"Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association\/American Stroke Association. Stroke. 2014;45:2160\u2013236.","journal-title":"Stroke"},{"key":"2370_CR17","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1016\/j.ahj.2009.07.035","volume":"159","author":"RD Lopes","year":"2010","unstructured":"Lopes RD, Alexander JH, Al-Khatib SM, Ansell J, Diaz R, Easton JD, et al. Apixaban for reduction in stroke and other ThromboemboLic events in atrial fibrillation (ARISTOTLE) trial: design and rationale. Am Heart J. 2010;159:331\u20139.","journal-title":"Am Heart J"},{"key":"2370_CR18","doi-asserted-by":"crossref","unstructured":"Pencina MJ, D'Agostino RB, Sr., D'Agostino RB, Jr., Vasan RS: Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med 2008, 27:157\u2013172; discussion 207\u2013112.","DOI":"10.1002\/sim.2929"},{"key":"2370_CR19","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1002\/sim.4780050506","volume":"5","author":"DJ Spiegelhalter","year":"1986","unstructured":"Spiegelhalter DJ. Probabilistic prediction in patient management and clinical trials. Stat Med. 1986;5:421\u201333.","journal-title":"Stat Med"},{"key":"2370_CR20","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1378\/chest.09-1584","volume":"137","author":"GY Lip","year":"2010","unstructured":"Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010;137:263\u201372.","journal-title":"Chest"}],"container-title":["BMC Cardiovascular Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12872-021-02370-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12872-021-02370-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12872-021-02370-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T06:06:05Z","timestamp":1636697165000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmccardiovascdisord.biomedcentral.com\/articles\/10.1186\/s12872-021-02370-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,12]]},"references-count":20,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["2370"],"URL":"https:\/\/doi.org\/10.1186\/s12872-021-02370-2","relation":{},"ISSN":["1471-2261"],"issn-type":[{"value":"1471-2261","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,12]]},"assertion":[{"value":"1 April 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 November 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 November 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study protocol was approved by Central Research Ethics Committee (CREC), the institutional review boards (IRBs) of the Thailand Ministry of Public Health and of each participating hospital as follows: the Institutional Review Board (IRB) of Faculty of Medicine, Siriraj Hospital, Mahidol University, Faculty of Medicine, Chulalongkorn University, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Faculty of Medicine, Chiang Mai University, Police General Hospital, Phramongkutklao College of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Central Chest Institute of Thailand, Faculty of Medicine, Prince of Songkla University, Faculty of Medicine, Thammasat University, Rangsit Campus, Faculty of Medicine, Naresuan University, Faculty of Medicine,Khon Kaen University, Golden Jubilee Medical Center, Charoen Krung Pracha Rak Hospital, Lampang Hospital, Nakornping Hospital, Prapokklao Hospital(Chanthaburi), Maharat Nakorn Ratchasima Hospital, Suratthani Hospital, Chonburi Hospital, Buddhachinaraj Hospital, Sapphasitthiprasong Hospital, Ratchaburi Hospital, Chiangrai Prachanukroh Hospital, Udonthani Hospital, Queen Savang Vadhana Memorial Hospital, Surin Hospital. Written informed consent was obtained from all included patients prior to participation, and the study was conducted in accordance with the principles set forth in the Declaration of Helsinki and the International Conference on Harmonization for Good Clinical Practice Guidelines.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"540"}}