Evaluation of the CHADS2 Risk Score on Short‐ and Long‐Term All‐Cause and Cardiovascular Mortality After Syncope. Issue 5 (28th February 2013)

• Record Type: Journal Article
• Authors: Ruwald, Martin Huth; Ruwald, Anne‐Christine; Jons, Christian; Lamberts, Morten; Hansen, Morten Lock; Vinther, Michael; Køber, Lars; Torp‐Pedersen, Christian; Hansen, Jim; Gislason, Gunnar Hilmar
• Is Part Of: Clinical cardiology. Volume 36:Issue 5(2013:May)
• Page Start: 262
• Page End: 268
• Publication Date: 2013-02-28
• Subjects: Cardiology -- Periodicals; 616.12005
• DOI: 10.1002/clc.22102
• Languages: English
• ISSNs: 0160-9289

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="clc22102-sec-0001" sec-type="section"> <title>Background</title> <p>Syncope risk stratification is difficult and has not been implemented clinically.</p> </sec> <sec id="clc22102-sec-0002" sec-type="section"> <title>Hypothesis</title> <p>The CHADS2 score can be applied as a risk stratification tool for predicting mortality after an episode of syncope.</p> </sec> <sec id="clc22102-sec-0003" sec-type="section"> <title>Methods</title> <p>All patients discharged from emergency departments with a first‐time diagnosis of syncope from 2001 to 2009 where identified from nationwide registers in Denmark and matched on sex and age with a control population. Risk of all‐cause or cardiovascular death was analyzed by multivariable Cox models.</p> </sec> <sec id="clc22102-sec-0004" sec-type="section"> <title>Results</title> <p>A total of 37 705 patients were included. There were a total of 7761 deaths (21%), of which 52% were cardiovascular vs 27 862 (15%) deaths in the control population. The risk of cardiovascular death was significantly increased with increasing CHADS<sub>2</sub> score (CHADS<sub>2</sub> score: 1–2, hazard ratio [HR]: 9.11, 95% confidence interval [CI]: 8.25‐10.07; CHADS<sub>2</sub> score: 3–4, HR: 17.32, 95% CI: 15.42‐19.47; CHADS<sub>2</sub> score: 5–6, HR: 26.66, 95% CI: 21.40‐33.21) relative to CHADS<sub>2</sub> score of 0. A CHADS<sub>2</sub> score of 0 was associated overall with very low event rates (15.1 deaths per 1000 person‐years) but was associated with increased relative risk in the syncope population compared to controls. Syncope predicted 1‐week, 1‐year, and long‐term mortality across CHADS<sub>2</sub> scores compared to controls but did not reach significance in CHADS<sub>2</sub> scores of 5 to 6.</p> </sec> <sec id="clc22102-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Increasing CHADS<sub>2</sub> score significantly predicts mortality in patients discharged with a diagnosis of syncope, and a CHADS<sub>2</sub> score of 0 was associated with a very low absolute mortality. Compared to controls, syncope was associated with increased short‐ and long‐term mortality, particularly in the lower CHADS<sub>2</sub> scores.</p> </sec> </abstract>