Use Of CHA2DS2-VASc Score Research Articles

The Use of CHA2DS2-VASc Score to Predict Functional Outcomes of Mechanical Thrombectomy

Background: Mechanical thrombectomy is widely used for revascularization of acute ischemic strokes from large vessel occlusions. Functional outcomes following mechanical thrombectomy are typically assessed using the modified Rankin scale. CHA2DS2-VASc score is commonly used to estimate the stroke risk of patients with atrial fibrillation, but studies have verified its use in other various situations. Our study aimed to assess the utility of CHA2DS2-VASc score in predicting outcomes of patients undergoing mechanical thrombectomy. Methods: We performed a single center retrospective study. Of patients with acute ischemic stroke who underwent mechanical thrombectomy for large vessel occlusion (n = 448). CHA2DS2-VASc score was calculated on each patient and the study population was grouped based on low-risk ≤ 2, intermediate risk 3-4 and high-risk ≥ 5. Association between CHA2DS2-VASc score and 90-day modified Rankin score as well as in-hospital, 30-day, and 1-year mortality was evaluated and compared between the three groups. Results: A total of 312 patients met criteria for the study. Patients in the high-risk CHA2DS2-VASc score had a significantly higher modified Rankin score (4.48) when compared to low (2.57) and intermediate (3.82) risk groups. Higher CHA2DS2-VASc scores were also associated with a significantly higher in-hospital, 30-day, and one year mortality. Conclusion: CHA2DS2-VASc score, a simple bed-side tool, can predict higher mortality and worse functional outcomes in acute ischemic stroke patients undergoing mechanical thrombectomy for large vessel occlusions.

Use of CHA2DS2-VASc score to predict the risk of ischemic stroke and mortality in patients who underwent coronary artery bypass grafting surgery: a retrospective cohort study.

Ischemic stroke and postoperative atrial fibrillation (POAF) are frequently seen after coronary artery bypass grafting (CABG). CHA2DS2-VASc scoring system is used to predict ischemic stroke and POAF. This study aimed to evaluate CHA2DS2-VASc scores in predicting ischemic stroke after CABG and analyze the effect of POAF on the relationship between CHA2DS2-VASc scores and ischemic stroke. Demographic and clinical characteristics of patients who underwent CABG were retrospectively recorded. CHA2DS2-VASc score was calculated for each patient and stratified into low- and high-risk groups. The heart rhythm of the patients was monitored during in-hospital follow-up and ischemic stroke was evaluated. Ischemic stroke and POAF were the primary and secondary outcomes. There were 383 patients (mean age of 63.1 ± 10.4 years). Ischemic stroke developed in eight (2.1%) patients. There were 248 (64.8%) high-risk patients with CHA2DS2-VASc scores. Patients with ischemic stroke were significantly older (p = 0.021) and had higher CHA2DS2-VASc scores (p < 0.001). Low and high-risk groups did not reveal any significant difference for ischemic stroke (p = 0.055). There were 56 (14.7%) patients with POAF. The relationship between CHA2DS2-VASc scores and ischemic stroke was not affected by POAF (p = 0.739). CHA2DS2-VASc scores of ≥3 predicted ischemic stroke (p < 0.001) with 100% sensitivity and 64.5% specificity. Ischemic stroke was associated with a higher mortality risk after CABG. Higher CHA2DS2-VASc scores were associated with higher ischemic stroke risk. POAF did not significantly affect the relationship between CHA2DS2-VASc scores and ischemic stroke. CHA2DS2-VASc score can be used to predict ischemic stroke and mortality following CABG.

Abstract 15288: The Use of Cha2ds2-vasc Score to Predict Functional Outcomes of Mechanical Thrombectomy

Introduction: Mechanical thrombectomy is a widely used form of revascularization for ischemic strokes secondary to large vessel occlusions. Functional outcomes are typically assessed following mechanical thrombectomy using the modified Rankin scale. CHA 2 DS 2 -VASc score is commonly used to estimate the stroke risk of patients with atrial fibrillation, but there are a plethora of studies showing it can be used in various situations. Our study aimed to assess the utility of CHA 2 DS 2 -VASc score in predicting outcomes of patients undergoing mechanical thrombectomy. Methods: We performed a single center, non-randomized, retrospective study. The study included 448 patients that underwent mechanical thrombectomy for large vessel occlusion strokes. CHA 2 DS 2 -VASc score was calculated on each patient and the study population was divided into 3 groups based on CHA 2 DS 2 -VASc score (Score ≤ 2, Score 3-4 and Score ≥ 5). Association between CHA 2 DS 2 -VASc score and 90-day modified Ranking score and in-hospital, 30-day, and one year mortality was evaluated and compared between the three groups. Results: A total of 312 patients met criteria for the study. Patients in the high risk CHA 2 DS 2 -VASc score had a significantly higher modified Rankin score (4.48) when compared to low (2.57) and intermediate (3.82) groups (Image 1). Higher CHA 2 DS 2 -VASc scores were also associated with a significantly higher in-hospital, 30-day, and one year mortality. Conclusion: CHA 2 DS 2 -VASc score can predict worse functional and survival outcomes in patients undergoing mechanical thrombectomy for a large vessel occlusion. CHA 2 DS 2 -VASc score ≥ 5 was associated with higher modified Rankin score and mortality.

Risk stratification for ischemic stroke and major bleeding in patients without atrial fibrillation – application of CHA2DS2-VASc and HAS-BLED scores

Abstract Background Atrial fibrillation (AF) is the most common arrhythmia. AF-related stroke tends to be more severe, and the mortality rate is higher compared with stroke without AF. Recent cardiac implantable electronic devices (CIEDs) have led to an improvement in the early detection of AF episodes. Previous studies showed that AF episodes detected by CIEDs are associated with ischemic stroke. However, little is known about the relationship between new-onset AF and ischemic stroke events in Japanese patients with CIEDs who have no prior AF and take no anticoagulant therapy. ESC guidelines for the management of AF recommend the use of CHA2DS2-VASc score as class I to predict the risk of ischemic stroke in patients with AF. However, the validity of the CHA2DS2-VASc and HAS-BLED scores to predict ischemic stroke and major bleeding events in patients without AF remains unclear. Objective The purpose of this study was to identify the incidence of ischemic stroke and major bleeding events in CIEDs patients without AF and assess the validity of CHA2DS2-VASc and HAS-BLED scores in this population. Methods We retrospectively analyzed the database of our CIEDs clinic. Every 6 months, CIEDs were checked using remote monitoring system. We examined the characteristics and incidence of ischemic stroke and bleeding events. In addition, we investigated the relationship between CHA2DS2-VASc and HAS-BLED scores and the incidence of these events. Results We enrolled 620 consecutive patients who were followed up at our CIED clinic. We excluded patients who had a history of AF or had received anticoagulant therapies, 348 patients (follow-up period, 65±58 months; age, 70±16 years; male sex; 64%; defibrillator, 55%) were included in this study. The mean CHA2DS2-VASc and HAS-BLED scores were 2.8±1.5 points and 1.7±1.6 points, respectively. During the follow-up, 23 (6.6%) and 12 (3.4%) of 348 patients had ischemic stroke and major bleeding events, respectively. The incidence of ischemic stroke and major bleeding events stratified by the CHA2DS2-VASc and HAS-BLED scores were shown in Figure 1. Conclusion The risk stratification for ischemic stroke and major bleeding using the CHA2DS2-VASc and HAS-BLED scores is valid in patients without AF. Funding Acknowledgement Type of funding sources: None. Figure 1

Usefulness of CHA2DS2-VAScScore to predict clinical outcomes of patients undergoing carotid artery stenting.

The CHA2DS2-VASc score predicts stroke and mortality risk in several cardiovascular diseases regardless of atrial fibrillation. In this study, we aimed to investigate the ability of CHA2DS2-VASc score to predict in-hospital and long-term outcomes in patients undergoing carotid artery stenting (CAS). The study population included 558 patients undergoing CAS. The patients were stratified into three groups based on their CHA2DS2-VASc scores [low (≤ 2, n = 123), moderate (3-5, n = 355) and high (6-8, n = 80)]. In-hospital and 3-year outcomes were compared between the groups. In-hospital rates of ipsilateral and major strokes and death were significantly different between the groups (1.6% vs. 3.9% vs. 16.2%; 1.6% vs. 4.5% vs. 16.2%; 0.8% vs. 3.1% vs. 13.8%, p < 0.001 for all, respectively). At 3years of follow-up, rates of ipsilateral and major strokes and death were significantly increased in patients with highscore compared to those with moderate and low scores (1.6% vs. 5.8% vs. 13%, p = 0.005; 0.8% vs. 5.2% vs. 13%, p = 0.001; 1.6% vs. 8.4% vs. 15.9%; p = 0.002, respectively). After adjusting for multi-model Cox regression analysis, CHA2DS2-VASc score persisted as an independent prognostic factor for mortality and major stroke in patients undergoing CAS. Higher CHA2DS2-VASc score predicted increased risk of in-hospital and 3- year stroke and mortality in patients undergoing CAS.

Authors' reply.

Sir, We thank the authors for their interest in our article[1] and for highlighting the issue of anticoagulation for atrial fibrillation (AF) in children with valvular heart disease (VHD). There is little doubt that AF independently increases the risk of stroke across all age groups, however, the AF-related stroke incidence varies.[2] The presence of concomitant VHD, regardless of the disease type and severity, further amplifies the risk of stroke and thromboembolic events in AF.[23] There are no published studies in pediatric patients, specifically addressing the risk of AF in VHD or the issue of anticoagulation in atrial arrhythmias. An important explanation for the lack of data is that AF is quite rare in the pediatric population, unlike in adults. Therefore, management experience from the adult literature is used as a surrogate and is extrapolated to the pediatric age group. There has been considerable heterogeneity in the definition of valvular and nonvalvular AF, and the definitions have changed with successive editions of major guidelines. A consensus[4] published in 2014 defined nonvalvular AF as AF in the absence of prosthetic mechanical heart valves or hemodynamically significant valve disease, while the term “nonvalvular AF” was no longer used in the recent update.[5] AF evidently leads to an increased risk for thromboembolism in patients with mitral stenosis, but there are limited data for other valvular diseases. There are currently no specific recommendations for thromboembolic prophylaxis in patients with AF and mitral or aortic regurgitation. Recent guidelines reiterate the assessment of stroke risk using the CHA2 DS2-VASc score for patients with nonvalvular AF.[5] Although the data on the use of CHA2 DS2-VASc score for anticoagulation in AF in children are sparse, the risk of stroke with AF in children is very low as per the scoring system. It needs to be highlighted that the CHADS2 risk score was developed for patients with nonvalvular AF, and hence, some studies suggested excluding patients with valve disease, particularly rheumatic mitral valve disease, for risk assessment using the CHADS2 score.[26] Darby et al.[3] recommended the use of systemic anticoagulation in all patients with rheumatic valvular disease with AF, unless there is a contraindication. Nonetheless, the recent guidelines recommend the use of CHA2 DS2-VASc score for deciding anticoagulation therapy in patients with AF and mitral or aortic regurgitation based on post hoc subgroup analyses of large randomized controlled trials.[7] The 2017 European guidelines for the management of VHDs are silent about the use of scoring system when deciding anticoagulation in this population, highlighting the heterogeneity in the recommendations on the issue. The authors mention that novel oral anticoagulants (NOACs) should be considered as an alternative to Vitamin K antagonists (VKAs) in patients with aortic stenosis, aortic regurgitation, and mitral regurgitation presenting with AF (Class IIa, level of evidence B).[8] However, there is a lack of data on the safety and efficacy of NOACs in children. As explained above, the statement in the current guidelines[1] is based on the conflicting evidence available from the studies in the adult population. The use of VKAs is reasonable in children with AF and mitral or aortic regurgitation. However, we agree that the “decision to anticoagulate” should be individualized in children and prospective randomized controlled trials are needed to formulate risk stratification system to guide the use of anticoagulation in this pediatric subset. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Acknowledgments The authors express thanks to Children's HeartLink Group (Ms. Bistra Zheleva, Ms. Adriana Dobrzycka, and Ms. Veera Rajasekhar), Pediatric Cardiac Society of India, and Dr. Arun Singh, National Advisor, Rashtriya Bal Swasthya Karyakram, Ministry of Health and Family Welfare, Government of India.

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

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 non-valvular 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 > ou = a 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 293 patients (93.5%) assessed, 167 were males, median age 76 (71–81) years. After a follow–up of 567 (432–665) days, 11.7% patients had adverse cardiovascular events, 8.6%patients had major bleeds, 10.8% patients died, and 24.6% 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 < .001), mortality (hazard ratio = 1.36; 95% confidence interval, 1.19–1.54, P < .001); and major adverse events (hazard ratio = 1.23; 95% confidence interval, 1.13-1.34; P < .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.

Usefulness of CHA2DS2-VASc Score to Predict Stroke Risk Independent of Atrial Fibrillation

The CHA2DS2-VASc score is used to predict stroke risk among patients with atrial fibrillation (AF). We examined whether a CHA2DS2-VASc score predicts stroke risk among individuals without hospital-diagnosed AF and quantified the magnitude of the association in comparison to AF patients. We used data from population-based medical registries (1995 to 2005) covering all Danish hospitals to identify patients diagnosed with AF (n = 122,980). We matched ≤5 non-AF individuals (n = 612,723) to each AF patient on the individual risk factors included in the CHA2DS2-VASc score. We calculated 10-year absolute risk of ischemic and all-cause stroke in AF and non-AF individuals and compared the stroke risk between cohorts within strata of CHA2DS2-VASc scores using Cox regression. The 10-year risk of ischemic/all-cause stroke was 4.4%/8.8% among non-AF individuals and 6.2%/12% in AF patients, corresponding to a risk difference of 1.8% for ischemic stroke and 3.3% for all-cause stroke. In both cohorts, the stroke risk correlated with increasing CHA2DS2-VASc scores. However, in individuals with CHA2DS2-VASc scores ≥5 who were <75 years or male, the absolute risk of ischemic stroke in individuals without AF exceeded the risk in AF patients. In the same subgroups, the hazard ratio approached unity. Similar results were observed for all-cause stroke. The CHA2DS2-VASc score was associated with 10-year stroke risk also among individuals without hospital-diagnosed AF. In conclusion, primary prophylactic anticoagulation therapy may be relevant in male and younger non-AF individuals with CHA2DS2-VASc scores ≥5. These findings should be confirmed in clinical trials.

The Risk of Stroke Using CHA2 DS2 -VASc Score in Hemodialysis Patients at a Tertiary Hospital in Riyadh, Saudi Arabia

Introduction: Patients undergoing hemodialysis are at increased risk of stroke. However, less known about the impact of some of the stroke risk factors, and the value of stroke risk scores in determining the risk in those patients. Our main goal. To assess the risk factors for stroke in hemodialysis patients and the use of the new CHA2DS2-VASc score for stroke assessment. Methods: Single center, retrospective cohort study of 336 patients undergoing hemodialysis from June 24, 2018, to September 6, 2018, was recruited. Baseline demographics, clinical, and laboratory data were collected. We calculated the CHA2 DS2 -VASc score for stroke assessment in all patients and categorized them into high, moderate and low risk patients according to CHA2 DS2 - VASc score and subcategorized them to two groups atrial fibrillation (AFib) and Non- Atrial fibrillation (Non AFib) patients. Results: 336 patients were included in our study; the majority of patients were at high risk with a CHA2 DS2 -VASc Score mean of 2.9± 1.5, although history of stroke was observed only in 15 patients (4.46%). According to CHA2 DS2 - VASc score, 280 patients were at high risk, 172 (51.19%) were high-risk patients on treatment (anticoagulant or antiplatelet) and 108(32.14%) patients were high risk patients not on treatment 48 were at moderate risk (14.28%) and 8 were at low risk (2.38 %). Patients were divided into subgroups as non-AFib and AFib. In non-AFib patients 320 (95.23%), high-risk patients 103 (32.18%) were not treated; high-risk patients with treatment are 162 (50.62%), moderate patients were 47 (14.68%), 8(2.5%) was in low risk. AFib patients were 16 with a mean CHA2 DS2 -VASc score of 4.4±1.1. Patients with AFib were all at high risk except 1 was at moderate risk (6.25%). There were 11 (68.75%) patients on treatment and 5 (31.25%) patients not on treatment. The risk factors for stroke that were statistically significant in increasing score risk for all patients were: age &gt; 65 (95% CI, -2.04– -1.29; p = 0.000), being female (95% CI, -1.36– -0.68; p = 0.000) hypertension (95% CI, -2.59– -1.37; p = 0.000), diabetes (95% CI, -2.10– -1.50; p = 0.000), CVD (95% CI, -2.07– -1.24; p=0.000), history of stroke or TIA (95% CI, -3.70– -2.03; p = 0.000), CHF or LVEF (95% CI, -2.28– - 0.91; p = 0.000). Conclusions: The risk of stroke in hemodialysis patients is significant according to the use of CHA2 DS2 -VASc score in Non-AFib hemodialysis patients shows supportive evidence of increased risk of stroke in those patients, which suggest the importance of close monitoring of patients with stroke risk factors by the nephrologist and the stroke team which will lead to the initiation of early prophylaxis in those patients.

The Use of CHA2DS2VASc Score in Predicting the Outcome of Electrical Cardioversion in Patients with Persistent atrial Fibrillation Immediately Post–Cardioversion and at 4 Weeks

The Use of CHA2DS2VASc Score in Predicting the Outcome of Electrical Cardioversion in Patients with Persistent atrial Fibrillation Immediately Post–Cardioversion and at 4 Weeks

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

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.

Usefulness of CHA2DS2-Vasc Score for Hyperthyroid Patients with Atrial Fibrillation

Usefulness of CHA2DS2-Vasc Score for Hyperthyroid Patients with Atrial Fibrillation

CHA2DS2-VASc Score as a Predictor of Adverse Outcomes in Patients Undergoing Percutaneous Coronary Intervention (PCI)

Introduction: CHA2DS2-VASc score is validated in predicting stroke risk in AF and provides a guide for management. We evaluated the use of CHA2DS2-VASc score in all-comers to predict mortality in patients undergoing PCI. Methods: CHA2DS2-VASc score was calculated on 18,818 patients undergoing PCI across 6 centres from 2005-2013. Clinical and procedural data, 30-day, 1-year and long-term outcomes were compared between the groups. Those with out-of-hospital cardiac arrest, cardiogenic shock and incomplete data set were excluded. NDI linked long-term follow-up was 3.44 ± 1.97 years. Results:Tabled 1CHA2DS2-VASc Scoren = 18,81830-day Mortality (%)12-Month Mortality (%)Long-term Mortality (%)1 (n = 2,983)0.20.83.62 (n = 4,599)0.21.26.43 (n = 4,427)0.82.211.34 (n = 3,501)1.13.917.45 (n = 2,075)1.85.525.56 (n = 840)3.78.931.27 (n = 287)3.58.739.78 (n = 86)8.119.848.89 (n = 20)5.015.055.0p Trend<0.001<0.001<0.001Area under the ROC (95% CI)0.74(0.71-0.78)0.71(0.69-0.73)0.71(0.70-0.72) Open table in a new tab Conclusion: The CHA2DS2-VASc score is an objective bedside risk assessment tool, which may be useful in predicting adverse outcomes in all patients undergoing PCI.

0415: Predictive value of the CHA2DS2-VASc score in atrial fibrillation patients at high risk for stroke despite oral anticoagulation

Introduction and objectives: 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 non valvular 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 > ou = a 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 293 patients (93.5%) assessed, 167 were males, median age 76 (71-81) years. After a followup of 567 (432-665) days, 11.7% patients had adverse cardiovascular events, 8.6%patients had major bleeds, 10.8% patients died, and 24.6% 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, 1.131.44; P<.001), mortality (hazard ratio=1.36; 95% confidence interval, 1.191.54, P<.001); and major adverse events (hazard ratio=1.23; 95% confidence interval, 1.13-1.34; P<.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.

Valor predictivo de la escala CHA2DS2-VASc en pacientes con fibrilación auricular de alto riesgo embólico en tratamiento anticoagulante

Introduction and objectivesThe 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. MethodsConsecutive outpatients with permanent/paroxysmal nonvalvular atrial fibrillation with CHA2DS2-VASc≥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 2.5-year-follow-up. ResultsOf 933 patients (93.5%) assessed, 432 were males, median age 76 (71-81) years. After a follow-up of 946 (782-1068) days, 109 patients (11.7%) had adverse cardiovascular events, 80 patients (8.6%) had major bleeds, 101 patients (10.8%) died, and 230 (24.6%) had major adverse events (composite end-point). 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<.001), mortality (hazard ratio=1.36; 95% confidence interval, 1.19-1.54; P<.001); and major adverse events (hazard ratio=1.23; 95% confidence interval, 1.13-1.34; P<.001). CHA2DS2-VASc score was not associated with major bleeding episodes. ConclusionsAmong high risk atrial fibrillation patients on oral anticoagulation, CHA2DS2-VASc successfully predicts cardiovascular events and mortality, but not major bleeds.Full English text available from:www.revespcardiol.org

Predictive Value of the CHA2DS2-VASc Score in Atrial Fibrillation Patients at High Risk for Stroke Despite Oral Anticoagulation

Introduction and objectivesThe 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. MethodsConsecutive outpatients with permanent/paroxysmal nonvalvular atrial fibrillation with CHA2DS2-VASc≥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 2.5-year-follow-up. ResultsOf 933 patients (93.5%) assessed, 432 were males, median age 76 (71-81) years. After a follow-up of 946 (782-1068) days, 109 patients (11.7%) had adverse cardiovascular events, 80 patients (8.6%) had major bleeds, 101 patients (10.8%) died, and 230 (24.6%) major adverse events (composite end-point). 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<.001), mortality (hazard ratio=1.36; 95% confidence interval, 1.19-1.54, P<.001); and major adverse events (hazard ratio=1.23; 95% confidence interval, 1.13-1.34; P<.001). CHA2DS2-VASc score was not associated with major bleeding episodes. ConclusionsAmong high risk atrial fibrillation patients on oral anticoagulation, CHA2DS2-VASc successfully predicts cardiovascular events and mortality, but not major bleeds.