CHADS₂ and modified CHA₂DS₂‐VASc scores for the prediction of congestive heart failure in patients with nonvalvular atrial fibrillation

Abstract

Background & purposeWe have conducted a retrospective observational study to analyze the correlation between the CHADS2 score, the modified CHA2DS2-VASc (mCHA2DS2-VASc) score, and the incidence of all-cause death and congestive heart failure (CHF).MethodsThe study cohort consisted of 292 consecutive patients with nonvalvular atrial fibrillation (NVAF) admitted to our hospital from 2012 to 2014. Electronic medical records were used to confirm medical history including prior heart failure, hypertension, diabetes, stroke, and coronary disease. A follow-up survey for all-cause deaths and incidence of CHF was carried out from the baseline data to May 2015. We analyzed the correlation between each score and the endpoints using the Kaplan-Meier method and the Cox proportional hazards model.ResultDuring the follow up period (mean=1.6 years), 69 all-cause deaths and 58 CHF events occurred in the cohort. There was no significant association between these scores and all-cause death in our CHF cohort. The incidence of CHF significantly increased along with increased CHADS2 (p=0.018) or mCHA2DS2-VASc scores (p=0.044). The hazard ratio (HR) for CHF after adjustment for drug treatment was obtained from a Cox proportional hazards model. The HRs for the CHADS2 and mCHA2DS2-VASc scores were 1.38 (95% CI; 1.13–1.68) and 1.35 (95% CI; 1.24–1.59), respectively.ConclusionCalculation of the CHADS2 and mCHA2DS2-VASc scores in order to evaluate the risk of systemic thromboembolism was useful to predict the onset of CHF, but not all-cause death, in patients with NVAF.

Stroke risk scores to predict hospitalization for acute decompensated heart failure in atrial fibrillation patients

“…Our results are consistent with previous studies that show a correlation for CHADS 2 and CHADS 2 -VASc with congestive HF [25] and all-cause cardiovascular hospitalisation [28].…”

“…In our study, independent predictors of decompensated HF were the ejection fraction and history of congestive HF. This suggests that history of HF is an important predictor of the recurrence of HF in AF patients, which is consistent with previous studies and reports [25].…”

“…Risk prediction for acute decompensated HF is especially important in AF patients since AF is highly associated with HF and also with an adverse prognosis in HF [25,26].…”

“…Although CHA 2 DS 2 -VASc and CHADS 2 were originally designed to stratify the risk of stroke in AF patients, recently they have been applied in studies with populations of various other pathologies [22,23]. For the other stroke risk scores, there is limited data on their ability to predict hospitalisation for HF decompensation [24,25].…”

CHA2DS2-VASc score, cerebral small vessel disease, and frailty in older patients with atrial fibrillation

“…Therefore, risk stratification for subsequent stroke or thromboembolism, treatment-related complications, and further functional decline in older population is important to determine individualised preventive or treatment strategy and goal of care. Among the risk stratification tools, the CHA 2 DS 2 -VASc (Congestive Heart Failure, Hypertension, Age ≥ 75 (doubled), Diabetes Mellitus, Prior Stroke or Transient Ischemic Attack (doubled), Vascular Disease, Age 65–74, Female) score can predict heart failure, cardiovascular hospitalisation, and death, and is thus widely used to identify the future risk of ischemic stroke 5 – 9 .…”