Evidence mapPaperPMID 42237411Full record

ArticleCardio-oncology (London, England)2026

Addition of malignancy into the CHADS2/CHA2DS2VASc score: better prediction of stroke risk in individuals with cancer and atrial fibrillation.

Zoha Majeed, Rochell Issa, Tess Calcagno, Ryan Issa, Neehal Shukla, Rohan Prasad, Arianne Clare Agdamag, David C Kaelber, Diego Sadler, Alok A Khorana and 2 more

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Article in Cardio-oncology (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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4 · The record

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5 · Who and what money

Authors and funding

12 authors.

Zoha Majeed *Department of Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA.
Rochell Issa *Department of Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA.
Tess CalcagnoDepartment of Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA.
Ryan IssaDepartment of Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA.
Neehal ShuklaDepartment of Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA.
Rohan PrasadDepartment of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA.
Arianne Clare AgdamagDepartment of Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA.
David C KaelberMetroHealth System, Cleveland, OH, USA.
Diego SadlerDepartment of Cardiology, Cleveland Clinic Foundation, Weston, FL, USA.
Alok A KhoranaDepartment of Medical Oncology, Taussig Cancer Center, Cleveland Clinic Foundation, Cleveland, OH, USA.
Mohamed KanjDepartment of Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA.
Rohit MoudgilDepartment of Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA. moudgir@ccf.org.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThe CHADS₂ and CHA₂DS₂VASc scoring systems guide thromboprophylaxis in atrial fibrillation (AF), but their performance is limited in patients with cancer. This study evaluated whether malignancy functions as an independent risk factor for ischemic stroke among patients with AF.

methodsUsing the TriNetX research network, we identified patients with AF with and without malignancy between 2015 and 2022, excluding those with prior cerebrovascular disease. Propensity score matching for CHA₂DS₂VASc variables and anticoagulation yielded two cohorts of 234,428 patients each. The primary outcome was ischemic stroke; secondary outcomes included major bleeding and all-cause mortality. Outcomes were assessed at 3 months, 6 months, 1 year, and 5 years following the index event.

resultsAt 3 months, stroke incidence was significantly higher among patients with AF and malignancy compared with AF alone (OR 2.092; CI 1.990-2.200). This increased risk persisted at 6 months (OR 1.978), 1 year (OR 1.795), and 5 years (OR 1.585). Mortality and major bleeding rates were also consistently higher in the AF and malignancy cohort across all time intervals.

conclusionPatients with AF and malignancy demonstrated a significantly higher risk of ischemic stroke despite matching for established CHA₂DS₂VASc risk factors, supporting malignancy as a potential independent contributor to stroke risk. Mortality and major bleeding were likewise higher, reflecting the combined burden of malignancy and AF. The relative odds of ischemic stroke exceeded those of major bleeding across all time points. Future studies should evaluate whether incorporating malignancy into the CHA₂DS₂VASc score improves stroke risk stratification in this population.

Indexed as

All-cause-mortalityAtrial fibrillationCHA2DS2VAScMajor bleedingMalignancyStroke

Identifiers

PMID42237411
PMCPMC13463736

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.