Usefulness of CHADS2, R2CHADS2, and CHA2DS2‐VASc scores for predicting incident atrial fibrillation in heart failure with preserved ejection fraction patients

Wu, Yuzhong; Xie, Zengshuo; Liang, Weihao; Xue, Rui‐De; Wu, Zexuan; Wu, Dexi; He, Jing; Zhu, Wenzhen; Liu, Chen

doi:10.1002/ehf2.13217

Cited by 11 publications

(9 citation statements)

References 26 publications

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“…3 Additionally, AF and other cardiovascular diseases share common risk factors, which are part of the components of the CHA 2 DS 2 -VASc score. Thus, several studies explored the predictive value of the CHA2DS2–VASc score in patients with cardiovascular diseases such as heart failure, 4,5 acute coronary syndrome 6 (ACS), valvular heart disease 7 (VHD) and thromboembolic events 8 (TE). However, the prognostic value of this score in CCU patients remains unclear.…”

Section: Introductionmentioning

confidence: 99%

The Association Between High CHA₂DS₂-VASc Scores and Short and Long-Term Mortality for Coronary Care Unit Patients

Cheng

Kang

Lin

et al. 2022

Clin Appl Thromb Hemost

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Background The CHA2DS2-VASc score has been associated with the prognosis of cardiovascular diseases. This study aimed to explore the association between the CHA2DS2-VASc score and all-cause mortality in coronary care unit (CCU) patients. Methods The study was based on the Medical Information Mart for Intensive Care (MIMIC) III database. CCU patients were divided into two groups according to CHA2DS2-VASc score: 0-3 (low risk)，4-9 (intermediate and high risk). The primary outcome was 30-day mortality, and the secondary endpoints included in-hospital, 1-year, and 5-year mortality. Propensity score matching (PSM) and sensitivity analyzes for the confounders were also performed. The restricted cubic splines flexibility model was used to demonstrate the relation between red blood cell volume distribution width (RDW), blood urea nitrogen (BUN), platelet, white blood cell (WBC), hemoglobin, phosphorus, glucose, potassium, sodium and 30-day mortality in the 0-3 score versus the 4-9 score groups after PSM. Results Among 4491 eligible patients, 988 patients with low CHA2DS2-VASc scores and 988 patients with intermediate and high CHA2DS2-VASc scores had similar propensity scores and were included in the analyzes. In the survival analysis, the patients with intermediate and high CHA2DS2-VASc scores were associated with higher 30-day mortality [hazard ratio (HR): 1.11; 95% confidence interval (CI), 1.02–1.20, P = .014], 1-year mortality [HR: 1.13; 95%CI, 1.06–1.19, P < .001], and 5-year mortality [HR: 1.13; 95%CI, 1.07–1.18, P < .001]. The interaction for 30-day mortality among subgroups was not significant between the 0-3 score versus the 4-9 score groups. The restricted cubic splines for 30-day mortality demonstrated an L-shaped trajectory for platelets and hemoglobin, a J-shaped trajectory for WBC, glucose and potassium, and a U-shaped trajectory for sodium, respectively (all nonlinear P <.001). Conclusions A high CHA2DS2-VASc score was an independent risk for 30-day, 1-year, and 5-year mortality for CCU patients.

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Section: Introductionmentioning

confidence: 99%

The Association Between High CHA₂DS₂-VASc Scores and Short and Long-Term Mortality for Coronary Care Unit Patients

Cheng

Kang

Lin

et al. 2022

Clin Appl Thromb Hemost

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“…This rate is higher than that observed in the TOPCAT trial, also in patients with HFpEF, that reported an incidence rate of 1.8 per 100 patient-years over a median follow-up of 3.3 years. 12 Empagliflozin did not lower the risk of new-onset atrial fibrillation. Similar findings have been reported in patients with HFrEF, in whom dapagliflozin did not reduce the risk of incident atrial fibrillation in patients in sinus rhythm at baseline.…”

Section: Discussionmentioning

confidence: 97%

Empagliflozin in heart failure with preserved ejection fraction with and without atrial fibrillation

Filippatos

Farmakis

Butler

et al. 2023

European J of Heart Fail

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AimsAtrial fibrillation/flutter (AF) is common in heart failure (HF) with preserved left ventricular ejection fraction (LVEF) and associated with worse outcomes. Empagliflozin reduces cardiovascular death or HF hospitalizations and slows estimated glomerular filtration rate (eGFR) decline in patients with HF and LVEF >40%. We aimed to assess the efficacy and safety of empagliflozin in improving outcomes in patients with HF and LVEF >40% with and without AF.Methods and resultsIn this pre‐defined secondary analysis of EMPEROR‐Preserved, we compared the effects of empagliflozin versus placebo on the primary and secondary endpoints and safety outcomes, stratified by baseline AF, defined as AF reported in any electrocardiogram before empagliflozin initiation or in medical history. Among 5988 patients randomized, 3135 (52%) had baseline AF; these patients were older, with worse functional class, more previous HF hospitalizations and higher natriuretic peptides compared to those without AF (all p < 0.001). After a median of 26 months, empagliflozin reduced cardiovascular death or HF hospitalization compared to placebo to a similar extent in patients with and without AF (hazard ratio [HR] 0.78 [95% confidence interval 0.66–0.93] vs. 0.78 [0.64–0.95], interaction p = 0.96). Empagliflozin also reduced total HF hospitalizations (HR 0.73 [0.57–0.94] vs. 0.72 [0.54–0.95], interaction p = 0.94) and annual eGFR decline (difference = 1.368 vs. 1.372 ml/min/1.73 m2/year, interaction p = 0.99) consistently in patients with and without AF. There was no increase in serious adverse events with empagliflozin versus placebo in patients with and without AF.ConclusionsIn patients with HF and ejection fraction >40%, empagliflozin reduced the risk of serious HF events and slowed the eGFR decline regardless of baseline AF.

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“…We previously showed that CHA 2 DS 2 ‐VASc (C statistic, 0.62) scores did not achieve an excellent predictive ability for stroke, regardless of AF status. 9 , 20 Abdul‐Rahim and coworkers developed a complicated model for stroke in patients with HFpEF without AF, with a higher performance from the CHARM‐Preserved (C statistic, 0.71) and I‐Preserve (C statistic, 0.73) trials; furthermore, the model worked exceptionally well with an external validation cohort of TOPCAT (C statistic, 0.73). 4 These results suggested the generality of risk scores across different baseline characteristics across the population.…”

Section: Discussionmentioning

confidence: 99%

“…The calculation of these risk scores has been described previously. 20 The C index of a BNP‐added risk‐predicting model versus existing risk‐predicting model was compared by using the method of Delong et al 21 The continuous net reclassification improvement (NRI) index and integrated discrimination improvement (IDI) index examined the improvement. CIs of C index, NRI scores, and IDI scores were computed by bootstrap resampling.…”

Section: Methodsmentioning

confidence: 99%

Usefulness of B‐Type Natriuretic Peptide for Predicting the Risk of Stroke in Patients With Heart Failure With Preserved Ejection Fraction

Liu

Abudukeremu

Yu³

et al. 2022

JAHA

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Background B‐type natriuretic peptide (BNP) is a well‐known biomarker for prognosis in heart failure with patients with preserved ejection fraction. However, the clinical predictive ability of BNP for the risk of stroke in HFpEF is not clear. Methods and Results A total of 799 patients with HFpEF from the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) trial were included. Association of baseline BNP with risk of stroke was assessed using the Cox proportional hazard model. The discriminatory ability of BNP was expressed using the C index. The improvement in 5‐year stroke prediction was assessed by C statistic, categorical net reclassification improvement index, and relative integrated discrimination improvement. A total of 34 (4.3%) patients among the 799 patients with HFpEF experienced stroke events over a median of 2.85 years of follow‐up. The stroke group showed a higher BNP level than the nonstroke group (375 pg/mL versus 241 pg/mL, respectively; P =0.006). Higher BNP levels were associated with increased risk of stroke after multivariable adjustment (hazard ratio, 3.29 [95% CI, 1.51–7.16]) and had a moderate performance for stroke prediction (C index, 0.67). Adding BNP to CHADS 2 /CHA 2 DS 2 ‐VASc/R 2 CHADS 2 scores improved their predictive value for stroke (CHADS 2 : C index, 0.67; BNP+CHADS 2 : C index, 0.77; net reclassification improvement, 40.9%; integrated discrimination improvement, 3.0%; CHA 2 DS 2 ‐VASc: C index, 0.64; BNP+CHA 2 DS 2 ‐VASc: C index, 0.74; net reclassification improvement, 41.4%; integrated discrimination improvement, 2.2%; R 2 CHADS 2 : C index, 0.70; BNP+R 2 CHADS 2 : C index, 0.78; net reclassification improvement, 40.9%; integrated discrimination improvement, 3.2%). Conclusions BNP is associated with an increased risk of stroke in patients with HFpEF and may be a valuable biomarker for stroke prediction in HFpEF.

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Usefulness of CHADS2, R2CHADS2, and CHA2DS2‐VASc scores for predicting incident atrial fibrillation in heart failure with preserved ejection fraction patients

Cited by 11 publications

References 26 publications

The Association Between High CHA₂DS₂-VASc Scores and Short and Long-Term Mortality for Coronary Care Unit Patients

The Association Between High CHA₂DS₂-VASc Scores and Short and Long-Term Mortality for Coronary Care Unit Patients

Empagliflozin in heart failure with preserved ejection fraction with and without atrial fibrillation

Usefulness of B‐Type Natriuretic Peptide for Predicting the Risk of Stroke in Patients With Heart Failure With Preserved Ejection Fraction

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Usefulness of CHADS2, R2CHADS2, and CHA2DS2‐VASc scores for predicting incident atrial fibrillation in heart failure with preserved ejection fraction patients

Cited by 11 publications

References 26 publications

The Association Between High CHA2DS2-VASc Scores and Short and Long-Term Mortality for Coronary Care Unit Patients

The Association Between High CHA2DS2-VASc Scores and Short and Long-Term Mortality for Coronary Care Unit Patients

Empagliflozin in heart failure with preserved ejection fraction with and without atrial fibrillation

Usefulness of B‐Type Natriuretic Peptide for Predicting the Risk of Stroke in Patients With Heart Failure With Preserved Ejection Fraction

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Product

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The Association Between High CHA₂DS₂-VASc Scores and Short and Long-Term Mortality for Coronary Care Unit Patients

The Association Between High CHA₂DS₂-VASc Scores and Short and Long-Term Mortality for Coronary Care Unit Patients