Assessment of the CHA2DS2-VASc Score for the Prediction of Death in Elderly Patients With Coronary Artery Disease and Atrial Fibrillation

Wu, Yangxun; Wang, Guanyun; Dong, Lixin; Qin, Liuan; Li, Jian; Yan, Hengming; Guo, Weichao; Feng, Xiaodong; Zou, Yuting; Wang, Ziqian; Du, Rina; Zhang, Yuxiao; Ma, Jing; Yin, Tong

doi:10.3389/fcvm.2021.805234

Cited by 8 publications

(11 citation statements)

References 41 publications

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“…The CHA2DS2-VASc score is a classical scoring system constructed to assess the thromboembolic risk and guide anticoagulant therapy in patients with atrial fibrillation and considers variables such as age (≥75 years: 2 points; 65–74 years: 1 point), female gender (1 point), heart failure (1 point), hypertension (1 point), diabetes (1 point), stroke (2 points), and vascular disease (1 point), which are easy to calculate [ 8 ]. The use of the CHA2DS2-VASc score has not only been validated in a population with nonvalvular atrial fibrillation but specific parameters have also been reported as independent predictors of stroke and death in the general population as well as in patients with coronary heart disease [ 9 ]. Studies have shown that the CHA2DS2-VASc score accurately predicts adverse events after acute coronary syndrome (ACS) [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Association of CHA2DS2-VASC Score with in-Hospital Cardiovascular Adverse Events in Patients with Acute ST-Segment Elevation Myocardial Infarction

Fang

Chen

Zhang

et al. 2022

International Journal of Clinical Practice

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Background. Acute ST-elevation myocardial infarction (STEMI) is a common clinical critical illness, and accurate, reliable, simple, and easy-to-remember tools are needed in clinical practice to quickly identify the risk of this condition in STEMI patients. This study investigates the predictive value of the admission CHA2DS2-VASc score for in-hospital MACE in STEMI patients. Methods. A total of 210 STEMI patients who visited the Chest Pain Center of the Second People‘s Hospital of Hefei from December 2019 to December 2021 were retrospectively analyzed. They were divided into MACE and non-MACE groups. The receiver operating characteristic curve (ROC) was used to assess the predictive value of the CHA2DS2-VASc score for MACE events during hospitalization. Results. The CHA2DS2-VASc score was higher in the MACE group than in the non-MACE group ( P < 0.05 ), and multivariate logistic regression analysis showed that the CHA2DS2-VASc score was an independent risk factor for MACE events during hospitalization in STEMI patients (OR = 1.391, 95%CI 1.044–1.853, P = 0.024 ); ROC curve analysis showed that the area under the curve (AUC) of the CHA2DS2-VASc score was 0.744, the sensitivity was 0.64, the specificity was 0.694, and the optimal cutoff value was 3.5 in predicting the risk of MACE events during hospitalization in STEMI patients. There were no significant differences between the GRACE score (0.744 VS.0.827) and TIMI score (0.744VS.0.745) ( P > 0.05 ). Conclusion. The CHA2DS2-VASc score can successfully predict the occurrence of in-hospital MACE events in STEMI patients.

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Section: Introductionmentioning

confidence: 99%

Association of CHA2DS2-VASC Score with in-Hospital Cardiovascular Adverse Events in Patients with Acute ST-Segment Elevation Myocardial Infarction

Fang

Chen

Zhang

et al. 2022

International Journal of Clinical Practice

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“…As shown in Table 2 , all simulated events in both arms were within 10% of relative difference when compared with the reported data from the mAFA-II trial. The simulated 5-year survival rate determined by the model (73.5%) was also compared to that reported (68.9%) for the Chinese elderly population with AF (CHA 2 DS 2 -VASc score of 3), and the relative difference was found to be 6.67% [ 31 ].…”

Section: Resultsmentioning

confidence: 99%

“…The model demonstrated accuracy with acceptable differences between simulated and reported rates. The higher 5-year survival rate generated in the present model was likely due to the model population being less elderly and having fewer comorbidities compared to patient characteristics in the cohort study [ 31 ]. For a more precise estimation of the cost-effectiveness over a lifetime scale, a clinical trial investigating the long-term effectiveness of mHealth-based care is highly warranted.…”

Section: Discussionmentioning

confidence: 99%

“…All model parameters were used to generate the cohort model. Model validation was performed by comparing the estimated incidence of events to the reported outcomes in the mAFA-II trial and comparing the simulated 5-year survival rate to that reported for the Chinese elderly population with AF [ 31 ]. The direct medical costs and QALYs of each comparator were calculated over a 30-year time horizon.…”

Section: Methodsmentioning

confidence: 99%

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Cost-Effectiveness of Mobile Health–Based Integrated Care for Atrial Fibrillation: Model Development and Data Analysis

Luo¹,

Xu²,

Ming³

et al. 2022

J Med Internet Res

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Background Mobile health (mHealth) technology is increasingly used in disease management. Using mHealth tools to integrate and streamline care has improved clinical outcomes of patients with atrial fibrillation (AF). Objective The aim of this study was to investigate the potential clinical and health economic outcomes of mHealth-based integrated care for AF from the perspective of a public health care provider in China. Methods A Markov model was designed to compare outcomes of mHealth-based care and usual care in a hypothetical cohort of patients with AF in China. The time horizon was 30 years with monthly cycles. Model outcomes measured were direct medical cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed to examine the robustness of the base-case results. Results In the base-case analysis, mHealth-based care gained higher QALYs of 0.0730 with an incurred cost of US $1090. Using US $33,438 per QALY (three times the gross domestic product) as the willingness-to-pay threshold, mHealth-based care was cost-effective, with an ICER of US $14,936 per QALY. In one-way sensitivity analysis, no influential factor with a threshold value was identified. In probabilistic sensitivity analysis, mHealth-based care was accepted as cost-effective in 92.33% of 10,000 iterations. Conclusions This study assessed the expected cost-effectiveness of applying mHealth-based integrated care for AF according to a model-based health economic evaluation. The exploration suggested the potential cost-effective use of mHealth apps in streamlining and integrating care via the Atrial fibrillation Better Care (ABC) pathway for AF in China. Future economic evaluation alongside randomized clinical trials is highly warranted to verify the suggestion and investigate affecting factors such as geographical variations in patient characteristics, identification of subgroups, and constraints on local implementation.

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“…Participants were included in the study if they had both SCAD and nonvalvular AF. SCAD includes stable angina, previous myopathy infarction and ischemic cardiomyopathy [19]. Nonvalvular atrial brillation refers to atrial brillation without mechanical valve prosthesis and rheumatic mitral stenosis [5,20].…”

Section: Patientsmentioning

confidence: 99%

Efficacy and safety of oral anticoagulants in elderly patients with stable coronary artery disease and atrial fibrillation

Zhang

et al. 2022

Preprint

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Background: This study aimed to evaluate the efficacy and safety of oral anticoagulants (OACs) in real-world elderly patients with comorbidities of stable coronary artery disease (SCAD) and atrial fibrillation (AF).Methods: Elderly patients (aged ≥ 65 years old) diagnosed with SCAD and AF were consecutively recruited and grouped into patients with or without OAC treatment. Follow-up was performed for 5 years. Major adverse cardiac events (MACEs) were defined as a composite of all-cause death, nonfatal myocardial infarction (MI), nonfatal stroke, and systemic embolism. Major bleeding outcomes were defined as events that were type ≥ 3 based on the Bleeding Academic Research Consortium (BARC) criteria. The net clinical outcomes were defined as the combination of MACEs and bleeding of BARC type ≥ 3.Results: A cohort of 832 eligible patients (78 ± 6.70 years) was included. Compared to the patients without OAC treatment (n=531, 63.82%), the patients treated with OAC (n=301, 36.18%) were much younger, had higher BMI, and had lower prevalence of heart failure, chronic obstructive pulmonary disease (COPD), renal insufficiency, and previous myocardial infarction. During the follow-up of 5 years, compared to the patients without OAC treatment, patients with OAC had a significantly lower risk of MACEs (20.60% vs. 58.95%, adjusted HR: 0.21, 95% CI: 0.15-0.30, p<0.001) but a higher risk of BARC ≥ 3 bleeding events (4.65% vs. 1.32%, adjusted HR: 4.71, 95% CI: 1.75-12.64, p = 0.002). In combination, a lower risk of net clinical outcomes could be observed in the patients with OACs (23.26% vs. 58.96%, adjusted HR: 0.27, 95% CI: 0.19-0.38, p<0.001). Among the patients with OAC treatment, no significant difference was found for MACEs or BARC ≥ 3 bleeding events between the patients with or without comedications of oral antiplatelet agents.Conclusions: A net clinical benefit of efficacy and safety could be observed in OAC-treated elderly patients with SCAD and AF. This benefit is independent of the comedications of oral antiplatelet treatment.

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Assessment of the CHA2DS2-VASc Score for the Prediction of Death in Elderly Patients With Coronary Artery Disease and Atrial Fibrillation

Cited by 8 publications

References 41 publications

Association of CHA2DS2-VASC Score with in-Hospital Cardiovascular Adverse Events in Patients with Acute ST-Segment Elevation Myocardial Infarction

Association of CHA2DS2-VASC Score with in-Hospital Cardiovascular Adverse Events in Patients with Acute ST-Segment Elevation Myocardial Infarction

Cost-Effectiveness of Mobile Health–Based Integrated Care for Atrial Fibrillation: Model Development and Data Analysis

Efficacy and safety of oral anticoagulants in elderly patients with stable coronary artery disease and atrial fibrillation

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