Usefulness of CHA2DS2‐VASc score to predict mortality and hospitalization in patients with inflammatory arthritis. (19th December 2019)

• Record Type: Journal Article
• Authors: Cioffi, Giovanni; Viapiana, Ombretta; Orsolini, Giovanni; Idolazzi, Luca; Fracassi, Elena; Ognibeni, Federica; Dalbeni, Andrea; Gatti, Davide; Carletto, Antonio; Fassio, Angelo; Rossini, Maurizio; Giollo, Alessandro
• Is Part Of: International journal of rheumatic diseases. Volume 23:Number 1(2020)
• Page Start: 106
• Page End: 115
• Publication Date: 2019-12-19
• Subjects: ankylosing spondylitis -- cardiovascular risk factors -- CHA2DS2‐VASc score -- clinical outcomes -- psoriatic arthritis -- rheumatoid arthritis; Rheumatology -- Periodicals; Rheumatology -- Asia -- Periodicals; Rheumatology -- Pacific Area -- Periodicals; Rheumatic Diseases -- Periodicals; Connective Tissue Diseases -- Periodicals; Immune System Diseases -- Periodicals; 616.723
• DOI: 10.1111/1756-185X.13751
• Languages: English
• ISSNs: 1756-1841

Abstract

Abstract: Background: Inflammatory arthritis including rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) are disorders at increased risk of morbidity and mortality for which a validated prognostic tool for facilitating clinical management is needed. CHA2 DS2 ‐VASc (congestive heart failure/hypertension/age diabetes/stroke/vascular disease/age/sex category) score was initially conceived and used to estimate thromboembolic risk in non‐valvular atrial fibrillation, and then successfully applied in community populations with sinus rhythm. We tested CHA2 DS2 ‐VASc‐score as a prognosticator of adverse outcomes in patients in sinus rhythm with RA/AS/PsA. Methods: Between March 2014 and March 2015, 414 patients (214 RA, 75 AS, 125 PsA) in sinus rhythm without cardiac disease were consecutively analyzed and prospectively followed‐up. Primary and co‐primary end‐points were a composite of all‐cause death/all‐cause hospitalization and CV death/CV hospitalization, respectively. Results: Patients were divided into LOWscore and HIGHscore groups if CHA2 DS2 ‐VASc was = 0/1 point or greater than 1 point, respectively. The HIGHscore group comprised 190 patients who were older with higher prevalence of CV risk factors and arthritis disease activity than 224 LOWscore patients. During a follow up of 36 months, the event rate for primary and co‐primary end‐point was 37% and 12% in the HIGHscore vs 22% and 4% in LOWscore group ( P = .001 and .002 respectively). At multivariate Cox regression analysis CHA2 DS2 ‐VASc‐score was related to primary end‐point (hazards ratio [HR] 1.30 [1.07‐1.59], P = .009) and co‐primary end‐point (HR 1.35 [1.01‐1.79], P = .04) independently of traditional CV risk factors analyzed individually and indexes of inflammation or disease duration. Conclusion: CHA2 DS2 ‐VASc‐score accurately identifies in the mid‐term patients in sinus rhythm with RA/AS/PsA at different risks for CV and non‐CV mortality and hospitalization.