CHA₂DS₂VASc score and adverse outcomes in middle-aged individuals without atrial fibrillation

Abstract

Aims The CHA2DS2VASc score is used to evaluate the risk of thromboembolic events in patients with non-valvular atrial fibrillation. We assessed the prognostic yield of CHA2DS2VASc for new-onset atrial fibrillation, cardiovascular morbidity and mortality in a non-atrial fibrillation population. Methods We analysed a population-based cohort of 22,179 middle-aged individuals with ( n = 3542) and without ( n = 18,367) a history of atrial fibrillation; we grouped the population into five CHA2DS2VASc strata (0–1–2–3–≥4), and compared the risk of major adverse cerebro-cardiovascular events and mortality. Furthermore, we analysed the annual incidence of atrial fibrillation across different CHA2DS2VASc strata. Results Over a median follow-up of 15 years, 1572 patients (6.9%) had ischaemic strokes, 2162 (9.5%) coronary events and 5899 (26%) died. The cumulative incidence of ischaemic stroke in CHA2DS2VASc ≥ 4 subjects without atrial fibrillation was similar to patients with atrial fibrillation and CHA2DS2VASc 2, with a 10-year crude incidence rate of 0.91 (95% confidence interval (CI) 0.68–1.19) and 1.13 (95% CI 0.93–1.36) ischaemic strokes per 100 patient-years, respectively. CHA2DS2VASc in a non-atrial fibrillation population showed higher predictive accuracy for ischaemic stroke compared with an atrial fibrillation population (area under the curve 0.60 vs. 0.56; P = 0.001). In multivariable Cox regression analysis, CHA2DS2VASc ≥ 2 was an independent predictor of all-cause death (adjusted hazard ratio (aHR) 2.58; 95% CI 2.42–2.76), cardiovascular death (aHR 3.40; 95% CI 2.98–3.89), ischaemic stroke (aHR 2.20; 95% CI 1.92–2.53) and coronary events (aHR 1.83; 95% CI 1.63–2.04). The cumulative incidence of atrial fibrillation was greater with increasing CHA2DS2VASc strata, with an absolute annual incidence of more than 2% per year if CHA2DS2VASc ≥ 4. Conclusion The CHA2DS2VASc score is a sensitive tool for predicting new-onset atrial fibrillation and adverse outcomes in subjects both with and without atrial fibrillation.

Efficacy and Safety of Oral Anticoagulants in Patients with Systolic Heart Failure in Sinus Rhythm: A Systematic Review and Meta-analysis of Randomized Controlled Trials and Cohort Studies

“…A risk score may predict the risk of stroke and bleeding risk and guide the need for OAC in HF patients with sinus rhythm. 35 Additionally, the effect of low-dose rivaroxaban and other DOACs on HF patients in sinus rhythm needs to be further explored.…”

Female Sex as a Thromboembolic Risk Factor in the Era of Nonvitamin K Antagonist Oral Anticoagulants

“…Of note, the CHA2DS2-VASc score has been evaluated as a predictor of new onset of AF, CV morbidity, and mortality in non atrial fibrillation population [ 41 ]. The authors analysed a population-based cohort of 22.179 middle-aged individuals, either with or without a history of AF (n.18.367), over a median follow-up of 15 years.…”

Optimal Antithrombotic Treatment of Patients with Atrial Fibrillation Early after an Acute Coronary Syndrome—Triple Therapy, Dual Antithrombotic Therapy with an Anticoagulant… Or, Rather, Temporary Dual Antiplatelet Therapy?

“…Ticagrelor and prasugrel have been clearly demonstrated to reduce the rate of cardiovascular events (cardiovascular death, reinfarction, and stroke) when compared to clopidogrel in the PLATO and TRITON-TIMI 38 trials, with a risk reduction within the first month of treatment ranging from 12% (ticagrelor) [ 8 ] to 22% (prasugrel) [ 9 ]. Since the incidence of cardiovascular events after ACS is also related, as is the embolic risk, to the CHA 2 DS 2 VASc score [ 23 , 24 ], we can expect a 30-day NNTB for cardiovascular events ranging from 179 (CHA 2 DS 2 VASc = 1) to 105 (CHA 2 DS 2 VASc = 9) with the use of ticagrelor instead of clopidogrel and from 97 (CHA 2 DS 2 VASc = 1) to 57 (CHA 2 DS 2 VASc = 9) with the use of prasugrel instead of clopidogrel ( Figure 4 ; see Online Appendix of [ 15 ] for calculations). The calculated equipoise between NNTBs for stroke versus coronary events is at CHA 2 DS 2 VASc = 4 for DAPT with ticagrelor instead of DAT and at CHA 2 DS 2 VASc = 5 for DAPT with prasugrel instead of DAT ( Figure 4 ).…”