Predictive value of the CHA2DS2-VASc score in atrial fibrillation patients at high risk for stroke despite oral anticoagulation: Algerian experience

Abstract

The risk of stroke in atrial fibrillation is heterogeneous and depends upon underlying clinical conditions included in current risk stratification schemes. Recently, the CHA2DS2-VASc score has been included in guidelines to be more inclusive of common stroke risk factors seen in everyday clinical practice, and useful in defining “truly low risk” subjects. We aimed to assess the usefulness of CHA2DS2-VASc score to give us an additional prognostic perspective for adverse events and mortality among “real world” anticoagulated patients with atrial fibrillation who are often elderly with many comorbidities. Consecutive outpatients with permanent/paroxysmal nonvalvular atrial fibrillation with CHA2DS2-VASc > ou = a 2 and stabilized oral anticoagulation (international normalized ratio 2.0–3.0) for at least the preceding 6 months were recruited. Patients with CHA2DS2-VASc ≥ 2 were selected. Adverse cardiovascular events including stroke, acute coronary syndrome, or heart failure; major bleeds; and mortality were recorded during more than 2-year follow-up. Of 393 patients (93.5%) assessed, 260 were males, median age 75 (71–81) years. After a follow-up of 690 (432–805) days, 11.6% patients had adverse cardiovascular events, 8.5% patients had major bleeds, 10.7% patients died, and 24.4% major adverse events (composite endpoint). Increasing CHA2DS2-VASc score by 1 point had a significant impact on the occurrence of cardiovascular events (hazard ratio = 1.27; 95% confidence interval, 1.13–1.44; P < 0.001), mortality (hazard ratio = 1.36; 95% confidence interval, 1.19–1.54, P < 0.001); and major adverse events (hazard ratio = 1.23; 95% confidence interval, 1.13–1.34; P < 0.001). CHA2DS2-VASc score was not associated with major bleeding episodes. Among high-risk atrial fibrillation patients on oral anticoagulation, CHA2DS2-VASc successfully predicts cardiovascular events and mortality, but not major bleeds.