CHA2DS2-VASc score, cerebral small vessel disease, and frailty in older patients with atrial fibrillation

Choi, Jung Yeon; Sunwoo, Leonard; Kim, Sun Wook; Kim, Kwang Il; Kim, Cheol Ho

doi:10.1038/s41598-020-75256-6

Cited by 5 publications

(4 citation statements)

References 31 publications

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“…As expected, studies show a positive correlation between CHA2DS2-VASc score and leukoaraiosis severity. In a study among nonvalvular AF patients aged 65 years or older, total WMH lesion volume was higher in those with increased risk of CHA2DS2-VASc score (n=40) than in those with intermediate risk (score of 1 in men or 2 in women) of CHA2DS2-VASc score (n=9) [ 29 ]. Using the Fazekas scoring system instead of volumetric measures for WMH may be partly the reason for our not finding an association.…”

Section: Discussionmentioning

confidence: 99%

Predictive Values of the CHA2DS2-VASc Score and Left Atrial Diameter for Cerebral Small Vessel Disease in Geriatric Patients With Atrial Fibrillation

Tanburoglu,

Karluka,

Diker

et al. 2023

Cureus

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Objective The objective of this study was to determine whether the CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes mellitus, stroke, vascular disease, age, sex) score and left atrial diameter (LAD) could predict the presence of cerebral small vessel disease (cSVD) in patients older than 65 years with atrial fibrillation as the cause of ischemic stroke. Materials and methods In this study, we included patients over 65 years of age who had suffered an ischemic stroke caused by atrial fibrillation within 30 days after the onset of symptoms. The data recorded included demographics, electrocardiograms, Holter monitors, and echocardiography reports. The anteroposterior LAD, determined by transthoracic echocardiography, was analyzed. Each patient's CHA2DS2-VASc score was calculated. Brain magnetic resonance imaging (MRI) assessed white matter hyperintensities (WMH) on fluid-attenuated inversion recovery (FLAIR) images and cerebral microbleeds (CMBs) on susceptibility-weighted sequences. The Fazekas score, based on WMH on MRI, was used to grade the severity of gliosis. Participants were categorized into three groups according to their quantitative CMB burden. Findings The study included 60 participants, with a mean age of 80 years (range 65-99), and 43.3% (n = 26) were male. The CHA2DS2-VASc score had a mean value of 4.21 (range 2-8), and the mean LAD was 4.17 (range 2.6-5.3) cm. The CHA2DS2-VASc score did not predict CMBs (OR, 1.389; 95% CI, 0.961-2.008, p = 0.08) in geriatric stroke patients with atrial fibrillation. However, in the subgroup of patients with diabetes mellitus, the CHA2DS2-VASc score was higher in those with CMB 1-4 and CMB ≥ 5 than in those without CMB. Additionally, the risk of CMBs 1-4 increased with higher LAD compared to patients without LAD. Conclusion The LAD and CHA2DS2-VASc scores were not significantly associated with CMB prediction in elderly stroke patients with atrial fibrillation. In a diabetes mellitus subgroup, the CHA2DS2-VASc score was indicative of CMB. An increased LAD elevates the risk of CMBs in patients with coronary artery disease.

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Section: Discussionmentioning

confidence: 99%

Predictive Values of the CHA2DS2-VASc Score and Left Atrial Diameter for Cerebral Small Vessel Disease in Geriatric Patients With Atrial Fibrillation

Tanburoglu,

Karluka,

Diker

et al. 2023

Cureus

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“…Studies on the mechanisms linking FS and CHA2DS2-VASc score in patients with AF are limited [ 36 , 70 ]. The PURE-Rhythm score update noted that the CHA2DS2-VASc score expresses complex clinical status and is inversely correlated with the Short Physical Performance Battery and Frailty Index.…”

Section: Frailty Syndrome and Atrial Fibrillationmentioning

confidence: 99%

Frailty Syndrome in Older Adults with Cardiovascular Diseases–What Do We Know and What Requires Further Research?

Wleklik

Denfeld

Lisiak

et al. 2022

IJERPH

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Cardiovascular diseases (CVD) affect 60% of people over 60 years of age and are one of the main causes of death in the world. Diagnosed cardiovascular disease also triples the likelihood of Frailty syndrome (FS). FS has become increasingly relevant in cardiology and cardiac surgery and occurs in a significant number of patients with CVD, with prevalence ranging from 25% to 62%. Viewed in a multidimensional, biopsychosocial perspective, FS increases a patient’s vulnerability, making them susceptible to several adverse clinical outcomes. Frailty syndrome also is a predictor of mortality in patients with CVD regardless of age, severity of disease, multi-morbidity, and disability. Frailty syndrome potentially can be prevented in patients with CVD and its early identification is important to avoid the development of disability, dependence on others and reduced quality of life. The aim of this paper is to show the relationship between FS and specific CVDs (coronary artery disease, hypertension, atrial fibrillation, heart failure) and cardiac procedures (device implantation, cardiac surgery, and transcatheter aortic valve implantation). Furthermore, we highlight those areas that require further research to fully understand the relationship between FS and CVD and to be able to minimize or prevent its adverse effects.

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“…The prevalence of frailty increases with age and is associated with various adverse outcomes, including falls, disability, long-term care, and death 7 . Moreover, a recent study demonstrated the relationship among the risk of ischemic stroke, cerebral small vessel disease, and frailty 8 .…”

Section: Introductionmentioning

confidence: 99%

Observational study of frailty in older Japanese patients with non-valvular atrial fibrillation receiving anticoagulation therapy

Matsui,

Kusano,

Akao

et al. 2024

Sci Rep

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The number of patients with atrial fibrillation is increasing, and frailty prevalence increases with age, posing challenges for physicians in prescribing anticoagulants to such patients because of possible harm. The effects of frailty on anticoagulant therapy in older Japanese patients with nonvalvular atrial fibrillation (NVAF) are unclear. Herein, we prescribed rivaroxaban to Japanese patients with NVAF and monitored for a mean of 2.0 years. The primary endpoint was stroke or systemic embolism. The secondary endpoints were all-cause or cardiovascular death, composite endpoint, and major or non-major bleeding. Frailty was assessed using the Japanese long-term care insurance system. A multiple imputation technique was used for missing data. The propensity score (PS) was obtained to estimate the treatment effect of frailty and was used to create two PS-matched groups. Overall, 5717 older patients had NVAF (mean age: 73.9 years), 485 (8.5%) were classified as frail. After PS matching, background characteristics were well-balanced between the groups. Rivaroxaban dosages were 10 and 15 mg/day for approximately 80% and the remaining patients, respectively. Frailty was not associated with the primary endpoint or secondary endpoints. In conclusion, frailty does not affect the effectiveness or safety of rivaroxaban anticoagulant therapy in older Japanese patients with NVAF.Trial registration: UMIN000019135, NCT02633982.

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CHA2DS2-VASc score, cerebral small vessel disease, and frailty in older patients with atrial fibrillation

Cited by 5 publications

References 31 publications

Predictive Values of the CHA2DS2-VASc Score and Left Atrial Diameter for Cerebral Small Vessel Disease in Geriatric Patients With Atrial Fibrillation

Predictive Values of the CHA2DS2-VASc Score and Left Atrial Diameter for Cerebral Small Vessel Disease in Geriatric Patients With Atrial Fibrillation

Frailty Syndrome in Older Adults with Cardiovascular Diseases–What Do We Know and What Requires Further Research?

Observational study of frailty in older Japanese patients with non-valvular atrial fibrillation receiving anticoagulation therapy

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