{"doi":"10.1101/2020.12.23.20248775","title":"Discrepancies in automated, electronic medical record-based CHA2DS2-VASc scores and clinician assessment for atrial fibrillation patients","abstract":"Abstract Background Clinical decision support tools for atrial fibrillation (AF) should include CHA 2 DS 2 - VASc scores to guide oral anticoagulant (OAC) treatment. Objective We compared automated, electronic medical record (EMR) generated CHA 2 DS 2 - VASc scores to clinician-documented scores, and report the resulting proportions of patients in the OAC treatment group. Methods Patients were included if they had both a clinician documented and EMR-generated CHA 2 DS 2 -VASc score on the same day. EMR scores were based on billing codes, left ventricular ejection fraction from echocardiograms, and demographics; documented scores were identified using natural language processing. Patients were deemed “re-classified” if the EMR score was ≥2 but the documented score was <2, and vice versa. For the overall cohort and subgroups (sex and age group), we compared mean scores using paired t-tests and re-classification rates using chi-squared tests. Results Among 5,767 patients, the mean scores were higher using EMR compared to documented scores (4.05 [SD 2.1] versus 3.13 [SD 1.8]; p<0.01) for the full cohort, and all subgroups (p<0.01 for all comparisons). If EMR scores were used to determine OAC treatment instead of documented scores, 8.3% (n=479, p<0.01) of patients would be re-classified, with 7.2% moving into and 1.1% moving out of the treatment group. Among 2,322 women, 4.7% (n=109, p<0.01) would be re-classified, with 4.1% into and 0.7% out of the treatment group. Among 3,445 men, 10.7% (n=370, p<0.01) would be re-classified, with 9.2% into and 1.5% out of the treatment group. Among 2,060 patients <65 years old, 18.1% (n=372, p<0.01) would be re-classified, with 15.8% into and 2.3% out of the treatment group. Among 1,877 patients 65-74 years old, 5.4% (n=101, p<0.01) would be re-classified, with 4.4% into and 1.0% out of the treatment group. Among 1,830 patients ≥75 years old, <1% would move into to the treatment group and none would move out of the treatment group. Conclusions EMR-based CHA 2 DS 2 -VASc scores were, on average, almost a full point higher than the clinician-documented scores. Using EMR scores in lieu of documented scores would result in a significant proportion of patients moving into the treatment group, with the highest re-classifications rates in men and patients <65 years old.","journal":"medRxiv","year":2020,"id":125713,"datarank":0.16479184330021646,"base_score":1.0986122886681096,"endowment":1.0986122886681096,"self_citation_contribution":0.16479184330021646,"citation_network_contribution":0.0,"self_endowment_contribution":0.16479184330021646,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9537,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":573160,"name":"Zameer Abedin","orcid":null,"position":1,"is_corresponding":false},{"id":573161,"name":"Olesya Ilkun","orcid":null,"position":2,"is_corresponding":false},{"id":500155,"name":"Rebeka Mukherjee","orcid":null,"position":3,"is_corresponding":false},{"id":572503,"name":"Mingyuan Zhang","orcid":"0000-0002-4444-0097","position":4,"is_corresponding":false},{"id":487093,"name":"Michael A. White","orcid":"0000-0001-8511-6026","position":5,"is_corresponding":false},{"id":337847,"name":"Benjamin A. Steinberg","orcid":"0000-0002-4729-7820","position":6,"is_corresponding":false},{"id":499215,"name":"Rashmee U. Shah","orcid":"0000-0002-7823-8540","position":7,"is_corresponding":false},{"id":499216,"name":"Aubrey Jones","orcid":"0000-0001-5523-6975","position":0,"is_corresponding":true}],"reference_count":13,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T23:15:19.482428Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}