Dataset Information

Predicting stroke and death in patients with heart failure using CHA₂DS₂-VASc score in Asia.

ABSTRACT:

Background

The CHA₂DS₂-VASc score is used to assess risk of mortality as well as to stratify risk of stroke in patients with atrial fibrillation (AF). This study evaluated whether CHA₂DS₂-VASc score was predictive of 1 and 2?year risks of stroke and death in Asian patients with heart failure (HF).

Methods

Patients hospitalized for HF were enrolled in the Korean Acute Heart Failure (KorAHF) registry, a prospective observational multicenter cohort study, between March 2011 and February 2014. Patients with a history of cancer before hospitalization for HF were excluded. The discriminatory properties of the CHA₂DS₂-VASc score were quantified using C-statistics.

Results

The study included 5158 patients with HF, 2091 with and 3067 without AF. Rates of stroke in these two groups were 4.5 and 2.8%, respectively, after 1?year, and 5.5 and 3.4%, respectively, after 2?years. Each 1-point increase in CHA₂DS₂-VASc score was associated with significantly increased risks of stroke and all-cause death in HF patients with and without AF (p-value 2DS₂-VASc score for all-cause death in patients with and without AF were 0.600 and 0.630, respectively, at 1?year and 0.626 and 0.635, respectively, at 2?years. The C-statistics for stroke ranged from 0.593 to 0.639.

Conclusions

Among patients with incident HF with and without AF, CHA₂DS₂-VASc score was significantly associated with the risks of stroke and death. However, CHA₂DS₂-VASc score was only a modest predictor of stroke and death, indicating the need for studies evaluating modified CHA₂DS₂-VASc scores. The majority of strokes occurred relatively shortly after hospitalization for HF and that mortality rates in patients with HF remain high. Thus, early treatment after HF to prevent stroke is essential.

SUBMITTER: Son MK

PROVIDER: S-EPMC6688312 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Publications

Predicting stroke and death in patients with heart failure using CHA<sub>2</sub>DS<sub>2</sub>-VASc score in Asia.

Son Mi Kyoung MK Lim Nam-Kyoo NK Park Hyun-Young HY

BMC cardiovascular disorders 20190808 1

<h4>Background</h4>The CHA<sub>2</sub>DS<sub>2</sub>-VASc score is used to assess risk of mortality as well as to stratify risk of stroke in patients with atrial fibrillation (AF). This study evaluated whether CHA<sub>2</sub>DS<sub>2</sub>-VASc score was predictive of 1 and 2 year risks of stroke and death in Asian patients with heart failure (HF).<h4>Methods</h4>Patients hospitalized for HF were enrolled in the Korean Acute Heart Failure (KorAHF) registry, a prospective observational multicente ...[more]

PMID: 31395009

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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.

Project description:BackgroundIn people with atrial fibrillation (AF), periods of sinus rhythm present an opportunity to detect prothrombotic atrial remodeling through measurement of P-wave indices (PWIs)-prolonged P-wave duration, abnormal P-wave axis, advanced interatrial block, and abnormal P-wave terminal force in lead V1. We hypothesized that the addition of PWIs to the CHA2DS2-VASc score would improve its ability to predict AF-related ischemic stroke.MethodsWe included 2229 participants from the ARIC study (Atherosclerosis Risk in Communities) and 700 participants from MESA (Multi-Ethnic Study of Atherosclerosis) with incident AF who were not on anticoagulants within 1 year of AF diagnosis. PWIs were obtained from study visit ECGs before development of AF. AF was ascertained using study visit ECGs and hospital records. Ischemic stroke cases were based on physician adjudication of hospital records. We used Cox proportional hazards models to estimate hazard ratios and 95% CIs of PWIs for ischemic stroke. Improvement in 1-year stroke prediction was assessed by C-statistic, categorical net reclassification improvement, and relative integrated discrimination improvement.ResultsAbnormal P-wave axis was the only PWI associated with increased ischemic stroke risk (hazard ratio, 1.84; 95% CI, 1.33-2.55) independent of CHA2DS2-VASc variables, and that resulted in meaningful improvement in stroke prediction. The β estimate was approximately twice that of the CHA2DS2-VASc variables, and thus abnormal P-wave axis was assigned 2 points to create the P2-CHA2DS2-VASc score. This improved the C-statistic (95% CI) from 0.60 (0.51-0.69) to 0.67 (0.60-0.75) in ARIC and 0.68 (0.52-0.84) to 0.75 (0.60-0.91) in MESA (validation cohort). In ARIC and MESA, the categorical net reclassification improvements (95% CI) were 0.25 (0.13-0.39) and 0.51 (0.18-0.86), respectively, and the relative integrated discrimination improvement (95% CI) were 1.19 (0.96-1.44) and 0.82 (0.36-1.39), respectively.ConclusionsAbnormal P-wave axis-an ECG correlate of left atrial abnormality- improves ischemic stroke prediction in AF. Compared with CHA2DS2-VASc, the P2-CHA2DS2-VASc is a better prediction tool for AF-related ischemic stroke.

Dataset Information

Predicting stroke and death in patients with heart failure using CHA₂DS₂-VASc score in Asia.

Background

Methods

Results

Conclusions

Publications

Predicting stroke and death in patients with heart failure using CHA<sub>2</sub>DS<sub>2</sub>-VASc score in Asia.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Dataset Information

Predicting stroke and death in patients with heart failure using CHA2DS2-VASc score in Asia.

Background

Methods

Results

Conclusions

Publications

Predicting stroke and death in patients with heart failure using CHA<sub>2</sub>DS<sub>2</sub>-VASc score in Asia.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Predicting stroke and death in patients with heart failure using CHA₂DS₂-VASc score in Asia.