Time trends in use of the CHADS2 and CHA2 DS2 VASc scores, and the geographical and specialty uptake of these scores from a popular online clinical decision tool and medical reference

Abstract

Background: The impact of the utilisation of such e-health approaches, including mHealth (use of mobile phones and other wireless technology in the delivery of medical care) assessments of health parameters, or the use of decision aids and online risk calculators over time have not been previously described. The objective of this analysis is to assess the time trends in use of the CHADS₂ and CHA₂ DS₂ VASc scores in e-health, and the geographical and specialty uptake of these scores, using data gleaned from a popular online clinical decision tool and medical reference, MDCalc. We hypothesised that the change in use of the scores would reflect the changes in guidelines and trends in clinical practice.

Results: The CHA₂ DS₂ VASc score was the 20th most popular calculator in 2012, rising to the second most popular calculator in 2018; the CHADS₂ score showed the converse, dropping from no. 3 to no. 22. Use of the CHA₂ DS₂ VASc scores particularly increased in the United States, Canada and Australia over time while the United Kingdom experienced a greater traffic share in 2015. The majority users of the CHADS₂ and CHA₂ DS₂ VASc scores were primary care physicians, with cardiologists being in the minority; the proportion of cardiologists was greater outside USA, compared to within USA.

Conclusion: Over time, use of the CHA₂ DS₂ VASc score increased, while use of the CHADS₂ score decreased. The change in uptake could partly be related to introduction of guidelines recommending the use of the CHA₂ DS₂ VASc score for stroke risk stratification.