Stroke Risk Stratification in Incident Atrial Fibrillation: A Sex-Specific Evaluation of CHA2DS2-VA and CHA2DS2-VASc

(1) Background: In the absence of locally validated tools, the CHA2DS2-VA score is suggested as a substitute for CHA2DS2-VASc score. This study compared potential discrepancies between these scores; (2) Methods: observational, retrospective, and community-based study included a cohort of 3,370 patients with new diagnosis of atrial fibrillation (AF) between January 01-2015 and December 31-2024; (3) Results: AF prevalence was 8.4%, significantly higher in men. Mean age was 80.1 (SD±6.24) years. Women (42.8%) were older (80.9 SD±6.1 vs. 79.5 SD±6.23; p < 0.001). Men had more diabetes mellitus, peripheral vascular disease, coronary artery disease, and chronic ob-structive pulmonary disease, as well as a higher Charlson Comorbidity Index. Con-versely, women exhibited a higher proportion ≥75 years, cognitive impairment, dyslipidemia, and higher stroke risk as assessed by the CHA2DS2-VASc score (p < 0.001), but not by the CHA2DS2-VA score (p = 0.071). The CHA2DS2-VA reduced the sex-based risk stratification differences, and only 3.2% of women were re-classified as being at very low risk (CHA2DS2-VA < 2); (4) Conclusions: The CHA2DS2-VA exhib-ited comparable predictive accuracy for thromboembolic events, with no sex-based disparities in the selection of ACO treatment modality. The clinical utility of CHA2DS2-VA remains a subject of ongoing debate.