Stroke predictors for atrial fibrillation - outside the CHA₂DS₂-VA

The use of oral anticoagulation to mitigate atrial fibrillation-related stroke is a core component of atrial fibrillation management. Current Australian guidelines use the CHA₂DS₂-VA clinical risk score to risk-stratify patients appropriate for oral anticoagulation. However, the efficacy of the CHA₂DS₂-VA is modest and has numerous limitations in clinical practice. The addition of novel risk factors to these scores may improve their predictive ability. This review article aims to identify clinical risk factors, biochemical markers, electrocardiogram features and cardiac imaging findings outside of the CHA₂DS₂-VA that have been found to increase the risk of stroke for patients with atrial fibrillation. The article proposes future directions using these novel risk factors to help further risk-stratify patients who may have initially been deemed low risk by the CHA₂DS₂-VA score and guide clinicians in prescribing anticoagulation.