Skip to main content

Research Repository

Advanced Search

Association between cancer, CHA2DS2VASc risk, and in-hospital ischaemic stroke in patients hospitalized for atrial fibrillation

Matetic, Andrija; Mohamed, Mohamed O; Essien, Utibe R; Guha, Avirup; Elkaryoni, Ahmed; Elbadawi, Ayman; Van Spall, Harriette G C; Mamas, Mamas A


Andrija Matetic

Mohamed O Mohamed

Utibe R Essien

Avirup Guha

Ahmed Elkaryoni

Ayman Elbadawi

Harriette G C Van Spall


Background Atrial fibrillation (AF) is commonly encountered in cancer patients. We investigated the CHA2DS2VASc score, and its association with in-hospital ischaemic stroke in patients with cancer who were hospitalized for AF. Methods and results Using the United States National Inpatient Sample, all hospitalizations with principal diagnosis of AF between October 2015 and December 2018 were stratified by cancer diagnosis, type, and CHA2DS2VASc risk categories (low risk, low-moderate risk, moderate-high risk). In-hospital ischaemic stroke and its association with the CHA2DS2VASc risk score was assessed across the groups using hierarchical multivariable logistic regression with adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Discrimination of CHA2DS2VASc score for in-hospital ischaemic stroke was evaluated with Receiver Operating Characteristic and Area Under the Curve (AUC). Among 1 341 870 included hospitalizations, 71 965 (5.4%) had comorbid cancer. Cancer patients had a higher proportion of moderate-high CHA2DS2VASc risk compared with their non-cancer counterparts (86.5% vs. 82.3%, P < 0.001). Compared with their low CHA2DS2VASc risk counterparts, cancer patients in low-moderate and moderate-high risk scores had similar odds of developing stroke (aOR 1.28 95% CI 0.22–7.63 and aOR 1.78 95% CI 0.41–7.66, respectively). The CHA2DS2VASc risk score had poor discrimination for ischaemic stroke in the cancer group (AUC 0.538 95% CI 0.477–0.598). Conclusion Cancer patients with AF have high CHA2DS2VASc risk. Discrimination of CHA2DS2VASc for ischaemic stroke is lower in cancer than non-cancer patients, and CHA2DS2VASc may not be adequate in determining ischaemic risk in cancer population.

Journal Article Type Article
Acceptance Date Dec 30, 2022
Online Publication Date Jan 3, 2023
Publication Date Dec 22, 2023
Journal European Heart Journal - Quality of Care and Clinical Outcomes
Print ISSN 2058-5225
Publisher Oxford University Press
Volume 9
Issue 8
Pages 749-757
Keywords Cardiology and Cardiovascular Medicine, Health Policy
Publisher URL