CHA2DS2-VASc score performance to predict stroke after acute decompensated heart failure with and without reduced ejection fraction. Issue 11 (7th August 2019)

• Record Type: Journal Article
• Authors: Berkovitch, Anat; Mazin, Israel; Younis, Arwa; Shlomo, Nir; Nof, Eyal; Goldenberg, Ilan; Beinart, Roy
• Is Part Of: Europace. Volume 21:Issue 11(2019)
• Page Start: 1639
• Page End: 1645
• Publication Date: 2019-08-07
• Subjects: Atrial fibrillation -- Heart failure -- Stroke -- Anticoagulation -- Acute heart failure -- Decompensated heart failure -- Tachyarrhythmia; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euz192
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Aims: To validate the utility of CHA2 DS2 -VASc score to predict the annual risk of stroke in patients admitted with acute heart failure, comparing those with preserved ejection fraction (HF-presEF) and reduced ejection fraction (HF-redEF). Methods and results: We investigated 2922 patients with known atrial fibrillation who were admitted to the Sheba Medical Center for acute decompensated heart failure (HF). Anticoagulation therapy was prescribed based on CHA2 DS2 -VASc score or physician's discretion. Subjects were divided into four pre-specified groups based on HF type and median CHA2 DS2 -VASc score: HF-presEF with CHA2 DS2 -VASc <5( N = 731), HF-presEF with CHA2 DS2 -VASc ≥5 ( N = 1102), HF-redEF with CHA2 DS2 -VASc <5 ( N = 563), and HF-redEF with CHADS2 -VASc ≥5 ( N = 526). The primary endpoint was an ischaemic stroke at 1 year. Mean age of the study population was 79 ± 11 years, of whom more than half were women. The median CHA2 DS2 -VASc score for the entire study population was 5.0 (interquartile range 25–75%: 4–6). Stroke rate for the entire study population was 6.6%. Multivariate Cox regression proportional hazards regression analysis revealed that in both HF-redEF and HF-presEF patients, each one-point increment in CHA2 DS2 -VASc was associated with a corresponding 28% increase in stroke risk ( P < 0.001). The Kaplan–Meier's survival analysis revealed that in the same CHADS2 -VASc category (high vs. low), no difference was found between HF-redEF and HF-presEF with regards to the risk of stroke. Conclusion: Our key finding is that the CHA2 DS2 -VASc score is a valid and powerful predictor of subsequent stroke among patients admitted with acute heart failure decompensation regardless of heart failure type.