CHA₂DS₂‐VASc score and adverse outcomes in patients with heart failure with reduced ejection fraction and sinus rhythm

Abstract

Aims To determine whether the CHA2DS2-VASc score can predict adverse outcomes such as death, ischemic stroke, and major hemorrhage, in patients with systolic heart failure in sinus rhythm. Methods and Results CHA2DS2-VASc scores were calculated for 1,101 patients randomized to warfarin and 1,123 patients randomized to aspirin. Adverse outcomes were defined as death or ischemic stroke, death alone, ischemic stroke alone, and major hemorrhage. Using proportional hazards models, we found that each 1-point increase in the CHA2DS2-VASc score was associated with increased hazard of death or ischemic stroke events (hazard ratio [HR] for the warfarin arm = 1.21 [1.13–1.30], p<0.001; for aspirin, HR = 1.20 [1.11–1.29], p<0.001). Similar increased hazards for higher CHA2DS2-VASc scores were observed for death alone, ischemic stroke alone, and major hemorrhage. Overall performance of the CHA2DS2-VASc score was assessed using c-statistics for full models containing the risk score, treatment assignment, and score-treatment interaction, with the c-statistics for the full models ranging from 0.57 for death to 0.68 for major hemorrhage. Conclusions The CHA2DS2-VASc score predicted adverse outcomes in patients with systolic HF in sinus rhythm, with modest prediction accuracy.

October 2016 at a glance: treatment of heart failure

“…Each 1‐point increase in the CHA 2 DS 2 ‐VASc score was associated with a 21% increase in the hazard of death or ischaemic stroke both in patients on warfarin and in those on aspirin. Similar results were found for death alone, ischaemic stroke alone, and major haemorrhage . These results are consistent with those of a recent large registry from Denmark showing an increase in the risk of thromboembolic events with higher CHA 2 DS 2 ‐VASc scores, in 136 545 patients admitted with HF in sinus rhythm .…”

Response by Di Tullio et al to Letter Regarding Article, “Left Ventricular Ejection Fraction and Risk of Stroke and Cardiac Events in Heart Failure: Data From the Warfarin Versus Aspirin in Reduced Ejection Fraction Trial”

“…However, as Chen and al. point out, the CHA 2 DS 2 -VASc score was only modestly predictive of stroke in WARCEF 4 . The addition of extra points for especially low LVEF, perhaps by creating for LVEF a two-tiered scoring system similar to that applied for age, might theoretically help refine the score’s predictive power in heart failure patients.…”

Stroke prevention in heart failure and sinus rhythm: where do we go from here?

“…In this issue of the journal, Ye et al present a post hoc analysis of the WARCEF trial evaluating the capacity of the CHA 2 DS 2 ‐VASc risk score to predict death, ischaemic stroke, and major haemorrhage in 2224 patients with HF in sinus rhythm. Rates of the composite endpoint and its components were significantly higher with each 1‐point increment in CHA 2 DS 2 ‐VASc score.…”