Predictive role of CHA₂DS₂-VASc score for cardiovascular events and death in patients with arterial hypertension and stable sinus rhythm

Abstract

Background The CHADS-VASc score well stratifies the risk for thromboembolic events in non-valvular atrial fibrillation (NVAF) patients. This score may also predict thromboembolic events in sinus rhythm populations. Purpose The purpose of this study was to assess the prognostic role of CHADS-VASc in a Caucasian community population of patients with arterial hypertension and sinus rhythm. Methods A total of 12,599 arterial hypertension residents not receiving anticoagulation were selected from a community population in Trieste between November 2009 and October 2014: 11,159 sinus rhythm and 1440 NVAF patients. We considered thromboembolic events, cardiovascular hospitalisation and all-cause death in all patients divided according to CHADS-VASc. Results Sinus rhythm patients were 74 (interquartile range 65-81) years old, 50% were women, 32% with CAD, mean CHADS-VASc 3.68 ± 1.47 points, significantly lower than NVAF patients (4.26 ± 1.50, P < 0.001). After 37 months follow-up, an increasing CHADS-VASc corresponded to a higher rate of thromboembolic events in sinus rhythm patients, ranging from 0% in patients with a score of 1 or 2 to 2.6% in those with a score of 6 or greater ( P < 0.0001). A similar trend was found in the reference NVAF group. At Cox multivariable analysis, CHADS-VASc predicted thromboembolic events (hazard ratio (HR) 2.12), cardiovascular hospitalisation (HR 1.55) and all-cause death (HR 1.57). The predictive accuracy of CHADS-VASc was similar in sinus rhythm and NVAF patients for thromboembolic events, cardiovascular hospitalisation and all-cause death (area under the curve statistic 0.76 vs. 0.76, 0.68 vs. 0.66, 0.64 vs. 0.64, respectively). Conclusions In a community population of Caucasian arterial hypertension patients in sinus rhythm, CHADS-VASc rather well stratifies for adverse clinical events at mid-term follow-up with a similar accuracy to NVAF patients. These results might be clinically relevant in this setting of sinus rhythm patients.

Usefulness of CHA2DS2‐VASc score to predict mortality and hospitalization in patients with inflammatory arthritis

“…International guidelines worldwide recommend to use CHA 2 DS 2 ‐VASc score for estimating the risk of stroke and managing antithrombotic therapy in patients with NVAF. Recently, some clinical investigations have fruitfully tested and validated the score as a predictor of adverse outcomes in populations with sinus rhythm and high risk for CV events . Our findings are in line with these experiences showing the usefulness of CHA 2 DS 2 ‐VASc score even in RA/AS/PsA disease analyzed in primary prevention.…”

“…The score takes into account the most powerful stroke risk factors including several traditional risk factors for adverse CV events. Recently, CHA 2 DS 2 ‐VASc score has been successfully applied in community populations with sinus rhythm and high risk for CV events, showing high accuracy as a prognosticator of CV events and death regardless of cardiac rhythm. This predictive accuracy has not been tested in patients suffering from RA/AS/PsA.…”

Association between clinical risk scores and mortality in atrial fibrillation: Systematic review and network meta-regression of 669,000 patients

“…Moreover, our data seem to suggest that the longer the follow-up time, the better the predictive ability of the CHA 2 DS 2 -VASc score. Furthermore, several data also indicate that the CHA 2 DS 2 -VASc score can help in identifying patients more likely to report thromboembolic events and cardiovascular events and death in patients without atrial fibrillation, 8,29,30 underlining how its model appears to be effective even beyond the evaluation of thromboembolic risk in atrial fibrillation patients.…”

Use of the CHA2DS2-VASc Score for Risk Stratification of Hospital Admissions Among Patients With Cardiovascular Diseases Receiving a Fourth-Generation Synchronous Telehealth Program: Retrospective Cohort Study

“…Furthermore, Mitchell et al showed that CHA 2 DS 2 -VASc scores could predict the incidence of stroke or transient ischemic attack in a population of over 20,000 patients with acute coronary syndrome without atrial fibrillation [10]. This scoring system can also predict various categories of cardiovascular hospitalization events other than cerebrovascular accident events; the scores themselves were a composite of inflammatory risk factors [11]. However, no studies have thus far addressed the utility of CHA 2 DS 2 -VASc scores to stratify patients via a telehealth program.…”