Dataset Information

The CHA₂DS₂-VASc score as a predictor of high mortality in hospitalized heart failure patients.

ABSTRACT:

Aims

Atrial fibrillation (AF) is common in patients with heart failure (HF). CHA₂DS₂-VASc score was originally employed as a risk assessment tool for stroke in patients with AF; however, it has recently been used to predict not only stroke but also various cardiovascular diseases beyond the original AF field. We aimed to verify the CHA₂DS₂-VASc score as a risk assessment tool to predict mortality in patients with HF.

Methods and results

Consecutive 1011 patients admitted for treatment of HF were divided into three groups based on their CHA₂DS₂-VASc scores: score 1-3 group (n = 317), score 4-6 group (n = 549) and score 7-9 group (n = 145). Of the 1011 HF patients, 387 (38.3%) had AF. We compared patient characteristics among the three groups and prospectively followed for all-cause mortality. Although left ventricular ejection fraction was similar among all three groups, all-cause mortality was higher in the score 4-6 group and score 7-9 group than in the score 1-3 group (37.9 and 29.3% vs. 15.1%, log-rank P < 0.001). In the multivariable Cox proportional hazard analysis, the CHA₂DS₂-VASc score 7-9 was an independent predictor of all-cause mortality (all HF patients: hazard ratio (HR) 1.822, P = 0.011; HF patients with AF: HR 1.951, P = 0.031; HF patients without AF: HR 2.215, P = 0.033).

Conclusions

The CHA₂DS₂-VASc score was an independent predictor of all-cause mortality in HF patients with or without AF. This comprehensive risk assessment score may help identify HF patients who are at high risk for mortality in HF patient.

SUBMITTER: Yoshihisa A

PROVIDER: S-EPMC5107970 | biostudies-literature | 2016 Dec

REPOSITORIES: biostudies-literature

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Publications

The CHA<sub>2</sub>DS<sub>2</sub>-VASc score as a predictor of high mortality in hospitalized heart failure patients.

Yoshihisa Akiomi A Watanabe Shunsuke S Kanno Yuki Y Takiguchi Mai M Sato Akihiko A Yokokawa Tetsuro T Miura Shunsuke S Shimizu Takeshi T Abe Satoshi S Sato Takamasa T Suzuki Satoshi S Oikawa Masayoshi M Sakamoto Nobuo N Yamaki Takayoshi T Sugimoto Koichi K Kunii Hiroyuki H Nakazato Kazuhiko K Suzuki Hitoshi H Saitoh Shu-Ichi SI Takeishi Yasuchika Y

ESC heart failure 20160718 4

<h4>Aims</h4>Atrial fibrillation (AF) is common in patients with heart failure (HF). CHA<sub>2</sub>DS<sub>2</sub>-VASc score was originally employed as a risk assessment tool for stroke in patients with AF; however, it has recently been used to predict not only stroke but also various cardiovascular diseases beyond the original AF field. We aimed to verify the CHA<sub>2</sub>DS<sub>2</sub>-VASc score as a risk assessment tool to predict mortality in patients with HF.<h4>Methods and results</h4> ...[more]

PMID: 27867527

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Project description:BackgroundChronic kidney disease (CKD) patients have a high prevalence of coronary artery disease and a high risk of cardiovascular events. The present study assessed the value of the CHA2DS2-VASc score for predicting mortality among hospitalized acute coronary syndrome (ACS) patients with CKD.MethodsThis was a retrospective cohort study that included CKD patients who were hospitalized for ACS from January 2015 to May 2020. The CHA2DS2-VASc score for each eligible patient was determined. Patients were stratified into two groups according to CHA2DS2-VASc score: <6 (low) and ≥6 (high). The primary endpoint was all-cause mortality.ResultsA total of 313 eligible patients were included in the study, with a mean CHA2DS2-VASC score of 4.55 ± 1.68. A total of 220 and 93 patients were assigned to the low and high CHA2DS2-VASc score groups, respectively. The most common reason for hospitalization was unstable angina (39.3%), followed by non-ST-elevation myocardial infarction (35.8%) and ST-elevation myocardial infarction (24.9%). A total of 67.7% of the patients (212/313) received coronary reperfusion therapy during hospitalization. The median follow-up time was 23.0 months (interquartile range: 12-38 months). A total of 94 patients (30.0%) died during follow-up. The high score group had a higher mortality rate than the low score group (46.2 vs. 23.2%, respectively; p < 0.001). The cumulative incidence of all-cause death was higher in the high score group than in the low score group (Log-rank test, p < 0.001). Multivariate Cox regression analysis indicated that CHA2DS2-VASc scores were positively associated with all-cause mortality (hazard ratio: 2.02, 95% confidence interval: 1.26-3.27, p < 0.001).ConclusionThe CHA2DS2-VASc score is an independent predictive factor for all-cause mortality in CKD patients who are hospitalized with ACS. This simple and practical scoring system may be useful for the early identification of patients with a high risk of death.

Project description:Background and Purpose- Despite modest predictive ability for ischemic stroke (IS), the CHA2DS2-VASc score is widely used for stroke prediction in atrial fibrillation. Among patients with atrial fibrillation, we aimed to (1) compare the IS or transient ischemic attack (TIA) incidence by CHA2DS2-VASc in blacks and Hispanics versus whites; (2) compare predictive ability of CHA2DS2-VASc score for IS or TIA in blacks and Hispanics versus whites; and (3) determine improvement in predictive ability of CHA2DS2-VASc score from addition of race/ethnicity. Methods- Using data from Optum Clinformatics, a large administrative claims database, we analyzed patients with atrial fibrillation enrolled in commercial and Medicare Advantage health plans from 2009 to 2015. We computed IS or TIA incidence rates, improvement in C statistic, continuous and categorical net reclassification improvement, and relative integrated discrimination improvement from addition of race/ethnicity to CHA2DS2-VASc. Results- A total of 267 419 patients (mean age, 73.1 [SD, 12.3] years; 46.6% women; 84.2% white, 8.5% black, 7.3% Hispanic) were studied. After a mean follow-up of 22 months, there were 6202 IS or TIA events. IS or TIA incidence rates were higher in blacks than Hispanics or whites (1.65, 1.40, and 1.22 cases per 100 person-years, respectively) and increased with higher CHA2DS2-VASc, with no race/ethnicity-based differences (P for interaction=0.17). The CHA2DS2-VASc and CHA2DS2-VASc+race/ethnicity C statistic (95% CI) were 0.679 (0.670-0.686) and 0.679 (0.671-0.688). The CHA2DS2-VASc C statistic in the 3 groups were comparable. With addition of race/ethnicity, the categorical net reclassification improvement, continuous net reclassification improvement, and relative integrated discrimination improvement were -0.045 (95% CI, -0.067 to -0.025), 0.045 (95% CI, 0.025-0.068), and 0.016 (95% CI, 0.014-0.018). Conclusions- The predictive ability of CHA2DS2-VASc for IS or TIA in atrial fibrillation is comparable among whites, blacks, and Hispanics; hence, it can be used in the latter 2 groups. Addition of race/ethnicity to the CHA2DS2-VASc does not improve its predictive ability.

Dataset Information

The CHA₂DS₂-VASc score as a predictor of high mortality in hospitalized heart failure patients.

Aims

Methods and results

Conclusions

Publications

The CHA<sub>2</sub>DS<sub>2</sub>-VASc score as a predictor of high mortality in hospitalized heart failure patients.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Dataset Information

The CHA2DS2-VASc score as a predictor of high mortality in hospitalized heart failure patients.

Aims

Methods and results

Conclusions

Publications

The CHA<sub>2</sub>DS<sub>2</sub>-VASc score as a predictor of high mortality in hospitalized heart failure patients.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

The CHA₂DS₂-VASc score as a predictor of high mortality in hospitalized heart failure patients.