CHA₂DS₂‐VASc score and clinical outcomes of patients with chest pain discharged from internal medicine wards following acute coronary syndrome rule‐out

Abstract

Background Chest‐pain patients deemed safe for discharge from internal medicine wards might still be at risk for adverse outcomes. Hypothesis CHA2DS2‐VASc score improves risk stratification of low‐risk chest‐pain patients discharged after acute coronary syndrome (ACS) rule‐out. Methods We accessed medical records of patients who were admitted to internal medicine wards at a single medical center during 2010–2016 and discharged following an ACS rule‐out. Patients were classified according to CHA2DS2‐VASc score: 0–1 (low), 2–3 (intermediate), >3 (high). Primary endpoint was occurrence of ACS at 1 year; 30‐day and 1‐year all‐cause mortality (ACM) were secondary outcomes. Results Of 12 449 patients, 7057 (57%) had low, 3781 (30%) intermediate, and 1611 (13%) high CHA2DS2‐VASc scores. Compared with a low score, intermediate and high scores were associated with significantly increased risk for 1‐year ACS during the first year (OR: 2.89, 95% CI: 1.91–4.37, P < 0.01 and OR: 4.84, 95% CI: 3.02–7.74, P < 0.01, respectively). Each 1‐point increase in CHA2DS2‐VASc was associated with a 37% increased risk for 1‐year ACS. A higher CHA2DS2‐VASc score was associated with significantly higher 30‐day ACM. Hazard ratios for 30‐day ACM were 1.9 (95% CI: 1.1–3.4, P = 0.03) and 4.4 (95% CI: 2.4–7.9, P < 0.01) for intermediate and high CHA2DS2‐VASc scores, respectively, compared with a low score. Each 1‐point increase in CHA2DS2‐VASc score was associated with 43% increased risk for 30‐day mortality. Conclusions High CHA2DS2‐VASc score (>3) was associated with adverse outcomes among chest‐pain patients discharged from internal medicine wards following ACS rule‐out.

Assessment of the CHA2DS2-VASc Score for the Prediction of Death in Elderly Patients With Coronary Artery Disease and Atrial Fibrillation

“…The CHA 2 DS 2 -VASc score [congestive heart failure, hypertension, age ≥75 years (doubled), diabetes, stroke/transient ischemic attack/thromboembolism (doubled), vascular disease (prior myocardial infarction, peripheral artery disease, or aortic plaque), age 65-74 years, sex category (female)] has been used for the assessment of thromboembolic (TE) risk and the guidance of antithrombotic treatment in patients with AF (20). In addition, this simple and well-established scoring system has been shown to predict the risk for other conditions beyond its original designations (20)(21)(22)(23)(24)(25)(26).…”

Value of the CHA2DS2‐VASc score for predicting outcome in patients with heart failure

“…High CHA 2 DS 2 -VASc score is associated with worse long term outcomes in patients with coronary disease, 16 acute coronary syndrome, 6 and even in patients who were evaluated for chest pain. 5 It is reasonable to assume that CHA 2 DS 2 -VASc score is valuable in HF, because its components are prognostic factors in HF. 17 There are limited data available regarding the CHA 2 DS 2 -VASc score in predicting HF outcomes in patients with HF.…”

“…Although the CHA 2 DS 2 ‐VASc score is recommended for the assessment of the risk of thromboembolic event in patients with AF, in recent years, it is used to predict outcomes in several other cardiovascular diseases. High CHA 2 DS 2 ‐VASc score is associated with worse long term outcomes in patients with coronary disease, 16 acute coronary syndrome, 6 and even in patients who were evaluated for chest pain 5 . It is reasonable to assume that CHA 2 DS 2 ‐VASc score is valuable in HF, because its components are prognostic factors in HF 17 …”

“…4 This simple and well-established score has been shown to predict risk for other conditions beyond its original field. Several studies have demonstrated an association between the CHA 2 DS 2 -VASc score and adverse outcomes in several cardiovascular conditions such as chest pain, 5 acute coronary syndrome, 6,7 acute myocardial infarction, 8 and pulmonary emboli, 9 regardless of the presence of AF.…”

CHA2DS2-VASc Score for Major Adverse Cardiovascular Events Stratification in Patients with Pneumonia with and without Atrial Fibrillation

“…The components of the CHA2DS2-VASc score include congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, prior stroke or transient ischemic attack (TIA) or thromboembolism, vascular disease, age 65–74 years, and sex category. Apart from the prediction of the risk of stroke, recent studies have shown an association between the score and outcome of acute myocardial infarction, stroke, and chest pain [ 14 , 15 , 16 ]. The CHA2DS2-VASc score is simple to apply in clinical practice.…”