CHA2DS2‐VASc score predicts atrial fibrillation recurrence after cardioversion: Systematic review and individual patient pooled meta‐analysis

Abstract

Background Despite progresses in the treatment of the thromboembolic risk related to atrial fibrillation (AF), the management of recurrences remains a challenge. Hypothesis To assess if congestive heart failure or left ventricular systolic dysfunction (CHA 2 DS 2 ‐VASc) score is predictive of early arrhythmia recurrence after AF cardioversion. Methods Systematic review and individual patient pooled meta‐analysis following Preferred Reporting Items for Systematic reviews and Meta‐Analyses guidelines. Inclusion criteria: observational trials in patients with AF undergoing cardioversion, available data on recurrence of AF and available data on CHA 2 DS 2 ‐VASc score. Clinical studies of interest were retrieved by PubMed, Cochrane Library, and Biomed Central. Seven authors were contacted for joining the patient level meta‐analysis, and three shared data regarding anthropometric measurements, risk factors, major comorbidities, and CHA 2 DS 2 ‐VASc score. The primary outcome was the recurrence of AF after cardioversion in patients free from antiarrhythmic prophylaxis. Univariate and multivariate logistic regression was performed. Results Overall, we collect data of 2889 patients: 61% were male, 50% with hypertension, 12% with diabetes, and 23% with history of ischemic heart disease. The median CHA2DS2‐VASc score was 2.. At the multivariate analysis, chronic kidney disease (odds ratio [OR] 1.94; 95% confidence interval [CI] 1.12‐3.27; P = 0.01), peripheral artery disease (OR 1.65; 95% CI 1.23‐2.19; P < 0,0001), previous use of beta blockers (OR 1.5; 95% CI 1.19‐1.88; P < 0.0001), and CHA2DS2‐VASc score > 2 (OR 1.37; 95% CI 1.1‐1.68; P = 0.002) were independent predictors of early recurrence of AF. Conclusions CHA2DS2‐VASc score predicts early recurrence of AF in the first 30 days after electrical or pharmacological cardioversion. Protocol registration PROSPERO (CRD42017075107).

Risk prediction of clinical adverse outcomes with machine learning in a cohort of critically ill patients with atrial fibrillation

“…Patients with pre-existing AF admitted for critical illness have a baseline thromboembolic risk which could be further raised by other factors related to the coexistent acute pathology, its treatment, organ dysfunctions and systemic inflammation 35 . CHA 2 DS 2 -VASc is a generic marker of risk, proven to be useful in several settings different from its original scope 36 . However, it is not validated for the critical illness, where it could be representative of the subject’s baseline risk, not considering the factors associated with the critical care environment.…”

CHA2DS2-VASc Score as a Predictor for Left Atrial Thrombus or Spontaneous Echo Contrast in Patients with Nonvalvular Atrial Fibrillation: A Meta-Analysis

“…CHA 2 DS 2 -VASc is a simple, clinical risk factor-based approach to thromboprophylaxis. Although the CHA2DS 2 -VASc score has been widely used to evaluate the risk recurrence of AF [7] and ischemic stroke in patients with AF [8], there has been limited evidence of LAT/LASEC prediction according to CHA2DS2-VASc scores. In 2015, a letter to an editor [9] reported that a high CHA 2 DS 2 -VASc score can predict LAT/LASEC by analyzing six relevant studies [10][11][12][13][14][15].…”

Sinus Rhythm Maintenance After Electrical Cardioversion for Atrial Fibrillation in High-Risk Patients — Comparative Efficacy of Antiarrhythmic Medications

“…high-risk AF, defined by CHA 2 DS 2 -VASc score 2 or higher for men and 3 or higher for women, according to the 2016 ESC Guidelines (Kirchhof et al, 2016), for included patients to be in more equivalent positions, adapting a factor predictive of being more susceptible to AF recurrence (Falsetti et al, 2014;Vitali et al, 2019) corresponding to the guidelines;…”

“…In addition, it is not only the use of antiarrhythmic medications that has an impact on sinus rhythm maintenance. For instance, it has been established that CHA 2 DS 2 -VASc score values of at least 2 are predictive of early AF recurrence after ECV (Falsetti et al, 2014;Vitali et al, 2019), suggesting that AF recurrence prevention in high-risk patients is more challenging.…”