# Additional Stroke Risk Factors Beyond the CHA2DS2-VA Score in Non-Valvular Atrial Fibrillation: An Interdisciplinary Expert Opinion

## TL;DR

This paper explores additional stroke risk factors beyond the CHA2DS2-VA score for non-valvular atrial fibrillation patients, aiming to improve clinical decision-making.

## Contribution

The paper introduces interdisciplinary expert insights on refining stroke risk prediction for patients with a CHA2DS2-VA score of 1.

## Key findings

- The CHA2DS2-VA score may be insufficient for many non-valvular atrial fibrillation patients with a score of 1.
- Combining clinical, lab, and imaging data with the CHA2DS2-VA score can improve stroke risk prediction.
- Expert recommendations suggest personalized approaches for better long-term cardiovascular outcomes.

## Abstract

Background/Objectives: Comorbidity and risk factor management and avoiding stroke are pillars of optimal atrial fibrillation management. In this article, the latest literature on additional stroke risk factors not included in the CHA2DS2-VA score is reviewed in patients with non-valvular atrial fibrillation (NVAF). The possible clinical impacts of the additional risk factors in NVAF patients with a CHA2DS2-VA score of 1 are compiled with insights in an interdisciplinary panel discussion to refine daily clinical practice. Methods: The panel was composed of three cardiologists, one endocrinologist, and a nephrologist. The panel members finalized twenty open-ended questions covering major problems in stroke risk stratification in NVAF patients with a score of 1. The shortcomings of this clinical-based model for stroke prevention and its possible outcomes were discussed with evidence-based recommendations. The meeting outcomes are addressed for daily clinical adaptation in the present article. Results: Recent evidence suggests that the CHA2DS2-VA score may have shortcomings in a striking rate of NVAF patients with a score of 1. The growing body of evidence suggests that combining clinical, laboratory, and imaging predictors with the CHA2DS2-VA score may further refine stroke risk prediction and aid in decision-making for anticoagulation of NVAF patients with a score of 1. Conclusions: The interdisciplinary expert panel offered several recommendations based on the assessment of additional risk factors, which may enable clinicians to identify individualized patient characteristics and early multidisciplinary prevention of disease progression and personalized improvements in the long-term cardiovascular outcomes in NVAF patients with a CHA2DS2-VA score of 1.