CHA2DS2-VASc score stratifies mortality risk in patients with and without atrial fibrillation
Objectives The CHA2DS2-VASc score is the preferred risk model for anticoagulation decision-making in atrial fibrillation (AF) patients. Recent studies have found this score to have prognostic value in other cardiovascular diseases. We assessed the relationships between CHA2DS2-VASc score and long-te...
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| Format: | Article |
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BMJ Publishing Group
2021-12-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/8/2/e001794.full |
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| author | Serge C Harb Leslie Cho Tom Kai Ming Wang Venu Menon Paul C Cremer Wael Jaber David Nemer Yuping Wu Osama Wazni |
| author_facet | Serge C Harb Leslie Cho Tom Kai Ming Wang Venu Menon Paul C Cremer Wael Jaber David Nemer Yuping Wu Osama Wazni |
| author_sort | Serge C Harb |
| collection | DOAJ |
| description | Objectives The CHA2DS2-VASc score is the preferred risk model for anticoagulation decision-making in atrial fibrillation (AF) patients. Recent studies have found this score to have prognostic value in other cardiovascular diseases. We assessed the relationships between CHA2DS2-VASc score and long-term mortality in adults referred for stress testing,Methods 165 184 consecutive patients from January 1991 to December 2014 from a prospective registry were studied, with CHA2DS2-VASc score calculated for all patients, and AF and anticoagulation status were recorded. The primary endpoint was all-cause mortality.Results In this cohort, 12 450 (7.5%) patients had AF and mean CHA2DS2-VASc score was 2.2±1.2. There were 22 152 (18.4%) deaths during mean follow-up of 6.1±4.8 years. In multivariable analysis, CHA2DS2-VASc score, presence of AF and anticoagulation use, along with end-stage renal failure and smoking were all independently associated with mortality with HRs (95% CIs) of 1.23 (1.21 to 1.25), 1.18 (1.10 to 1.27) and 1.50 (1.40 to 1.60), respectively. Higher CHA2DS2-VASc score was incrementally associated with worse survival both in patients with and without AF (log-rank p<0.001). Anticoagulation use was associated with reduced survival in non-AF patients with alternative anticoagulation indications at all CHA2DS2-VASc score categories, and AF patients with lower CHA2DS2-VASc score 0–2, but was protective in AF patients with higher CHA2DS2-VASc score 4–9.Conclusion Incrementally higher CHA2DS2-VASc score, a simple clinical tool, is associated with mortality in patients regardless of presence of AF and anticoagulation status. Anticoagulation use was associated with worse survival in non-AF patients and AF patients with low CHA2DS2-VASc scores, but was protective in AF patients with high CHA2DS2-VASc scores. |
| format | Article |
| id | doaj-art-4268bb39083a4608a4f72c2a69bf6ac6 |
| institution | Kabale University |
| issn | 2053-3624 |
| language | English |
| publishDate | 2021-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj-art-4268bb39083a4608a4f72c2a69bf6ac62024-11-11T14:20:10ZengBMJ Publishing GroupOpen Heart2053-36242021-12-018210.1136/openhrt-2021-001794CHA2DS2-VASc score stratifies mortality risk in patients with and without atrial fibrillationSerge C Harb0Leslie Cho1Tom Kai Ming Wang2Venu Menon3Paul C Cremer4Wael Jaber5David Nemer6Yuping Wu7Osama Wazni8Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USACardiovascular Medicine (Invasive & Interventional Cardiology Section), Cleveland Clinic, Cleveland, Ohio, USADepartment of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USADepartment of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USACardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USADepartment of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USACardiovascular Medicine (Cardiac Electrophysiology and Pacing Section), Cleveland Clinic, Cleveland, Ohio, USAMathematics, Cleveland State University, Cleveland, Ohio, USACardiovascular Medicine (Cardiac Electrophysiology and Pacing Section), Cleveland Clinic, Cleveland, Ohio, USAObjectives The CHA2DS2-VASc score is the preferred risk model for anticoagulation decision-making in atrial fibrillation (AF) patients. Recent studies have found this score to have prognostic value in other cardiovascular diseases. We assessed the relationships between CHA2DS2-VASc score and long-term mortality in adults referred for stress testing,Methods 165 184 consecutive patients from January 1991 to December 2014 from a prospective registry were studied, with CHA2DS2-VASc score calculated for all patients, and AF and anticoagulation status were recorded. The primary endpoint was all-cause mortality.Results In this cohort, 12 450 (7.5%) patients had AF and mean CHA2DS2-VASc score was 2.2±1.2. There were 22 152 (18.4%) deaths during mean follow-up of 6.1±4.8 years. In multivariable analysis, CHA2DS2-VASc score, presence of AF and anticoagulation use, along with end-stage renal failure and smoking were all independently associated with mortality with HRs (95% CIs) of 1.23 (1.21 to 1.25), 1.18 (1.10 to 1.27) and 1.50 (1.40 to 1.60), respectively. Higher CHA2DS2-VASc score was incrementally associated with worse survival both in patients with and without AF (log-rank p<0.001). Anticoagulation use was associated with reduced survival in non-AF patients with alternative anticoagulation indications at all CHA2DS2-VASc score categories, and AF patients with lower CHA2DS2-VASc score 0–2, but was protective in AF patients with higher CHA2DS2-VASc score 4–9.Conclusion Incrementally higher CHA2DS2-VASc score, a simple clinical tool, is associated with mortality in patients regardless of presence of AF and anticoagulation status. Anticoagulation use was associated with worse survival in non-AF patients and AF patients with low CHA2DS2-VASc scores, but was protective in AF patients with high CHA2DS2-VASc scores.https://openheart.bmj.com/content/8/2/e001794.full |
| spellingShingle | Serge C Harb Leslie Cho Tom Kai Ming Wang Venu Menon Paul C Cremer Wael Jaber David Nemer Yuping Wu Osama Wazni CHA2DS2-VASc score stratifies mortality risk in patients with and without atrial fibrillation Open Heart |
| title | CHA2DS2-VASc score stratifies mortality risk in patients with and without atrial fibrillation |
| title_full | CHA2DS2-VASc score stratifies mortality risk in patients with and without atrial fibrillation |
| title_fullStr | CHA2DS2-VASc score stratifies mortality risk in patients with and without atrial fibrillation |
| title_full_unstemmed | CHA2DS2-VASc score stratifies mortality risk in patients with and without atrial fibrillation |
| title_short | CHA2DS2-VASc score stratifies mortality risk in patients with and without atrial fibrillation |
| title_sort | cha2ds2 vasc score stratifies mortality risk in patients with and without atrial fibrillation |
| url | https://openheart.bmj.com/content/8/2/e001794.full |
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