Prediction of acute coronary syndrome, ischemic stroke, and mortality in patients with heart failure: a comparison of CHA2DS2-VASc and AHEAD scores.

Abstract

To compare the predictive capacity of the CHA2DS2-VASc and AHEAD scores in predicting acute coronary syndrome (ACS), ischemic stroke (IS), and mortality in patients with heart failure (HF). A total of 404,635 patients hospitalized for HF between 2000 and 2011 were recruited from a large national database in Taiwan. The predictive value of both scores was evaluated by analysis of the area under the receiver operating characteristic curve (AUROC), and the difference in their discriminative capacity was assessed using the DeLong test. The AUROC for the CHA2DS2-VASc score was significantly higher than that for the AHEAD score in predicting ACS and IS: 0.53 (95% CI = 0.53-0.54) versus 0.51 (95% CI = 0.51-0.52) for ACS, and 0.57 (95% CI = 0.56-0.57) versus 0.52 (95% CI = 0.51-0.52) for IS, respectively (all DeLong tests p < 0.001). By contrast, for mortality risk, the AUROC was significantly lower for the CHA2DS2-VASc score (0.56, 95% CI = 0.55-0.56) than the AHEAD score (0.60, 95% CI = 0.59-0.60; DeLong test p < 0.001). The ability of the CHA2DS2-VASc score to predict macrovascular complications (ACS and IS) in HF patients was higher than that of AHEAD.