CHA2DS2-VASc score as a predictor of long-term cardiac outcomes in elderly patients with or without atrial fibrillation
Clinical Interventions in Aging
ChA Ds -VAsc score as a predictor of long- 2 2 term cardiac outcomes in elderly patients with or without atrial fibrillation
Yunli Xing 0
Mei Tang 0
Kan Zhang 0
Dai Zhang 0
Deqiang Zhang 0
Qing Ma 0
0 Department of geriatrics and g erontology, Beijing Friendship hospital, Capital Medical University , Beijing , People's Republic of China
from ropF PowerdbyTCPDF(ww.tcpdf.org) Ying sun hongwei li Wei huang Background: The CHA2DS2-VASc score is often used for stroke risk stratification in atrial fibrillation (AF) patients. However, its usefulness in patients $75 years of age with or without AF is unclear. with and without AF. Objective: We aimed to investigate whether the CHA2DS2-VASc score can predict ischemic stroke (IS), transient ischemic attack, thromboembolism (TE), and mortality in elderly patients Materials and methods: During 2013-2014, 1,071 patients (36.3% with concomitant AF) at least 75 years old were enrolled, and the follow-up ended on July 15, 2017. Variables included sociodemographic characteristics, complications, drugs taken, laboratory results, and echocardiographic parameters. The primary end points were IS, transient ischemic attack, and TE, expressed as IS/TE. All-cause mortality was a secondary end point. Survival curves and mortality risks were assessed via Kaplan-Meier survival analysis and compared by log-rank tests. Results: The average follow-up duration was 2.57±1.37 years. Overall, 167 patients (5.6%) died and 77 (7.2%) developed IS/TE. The CHA2DS2-VASc score was associated with IS/TE in patients 75 years or older with and without AF, and patients with a CHA2DS2-VASc score $5 had a higher risk of stroke. However, the CHA2DS2-VASc score was not related to all-cause mortality. Conclusion: The CHA2DS2-VASc score can predict IS/TE, but not mortality, in elderly patients ($75 years) with or without AF.
CHA2DS2-VASc score; atrial fibrillation; elderly; stroke; survival
-
d
e
d
a
o
l
n
w
o
d
g
n
i
g
A
n
i
s
n
o
it
n
e
v
r
e
t
n
lI
a
c
i
n
il
C
open access to scientific and medical research
Introduction
Age is associated with increased risks of stroke and mortality in patients with either
atrial fibrillation (AF) or sinus rhythm.1 Measures to identify individuals with an
elevated risk of stroke would facilitate the early application of prevention strategies,
and thus, reliable stroke risk prediction schemes are urgently needed.
The CHA DS2-VASc (congestive heart failure, hypertension, age $75 years [double
2
score], diabetes, prior stroke or transient ischemic attack [TIA; double score], vascular
disease, age 65–74 years, sex class [female]) scoring system has gained prominent
status as a key prediction tool for stroke risk stratification in patients with AF.2 In
recent years, the value of the CHA DS2-VASc score for predicting ischemic stroke
2
(IS) and mortality has been shown to extend beyond the original field to heart failure
and myocardial infarction.3–5 In this study, we hypothesized that the CHA DS2-VASc
2
score can also predict IS and mortality in elderly patients with or without AF.
8
1
0
2
l
u
J
3
1
n
o
5
0
2
.
7
.
8
6
.
1
5
y
b
/
m
o
c
.
s
s
e
r
Materials and methods
A retrospective study was conducted by enrolling consecutive
patients aged 75 years or older at Beijing Friendship Hospital
between January 1, 2013 and December 31, 2014. The data
for all individual patients could be retrieved as all data at
our hospital are linked to a unique permanent registration
number. Diagnosis of AF was based on electrocardiography,
24-hour Holter monitoring, or the patient’s medical history of
AF.6,7 We excluded patients with mechanical prosthetic heart
valves, pulmonary embolism, or recent deep vein thrombosis
and intraventricular thrombus. Patients who had been on oral
anticoagulation therapy within the previous 3 months were
excluded from the study.
Ethical approval was obtained from the Ethical
Committee of Beijing Friendship Hospital, and all patients provided
written informed consent to participate in this research
study.
Follow-up was performed by reviewing data in medical
.vdoepww l.syoeun trheceohrodsspoirtaflrodmatatbelaespeh.oDnaetaincteorlvleicetweds tdhuartiwngerteheavfaoilllaobwle-uipn
Risk stratification using CHA2Ds 2-VAsc
score
The CHA2DS2-VASc score was calculated for each patient
according to the current clinical guidelines. The score
ranges from 0 to 9 points and includes the following clinical
characteristics: congestive heart failure or left ventricular
dysfunction (1 point), hypertension (1 point), age $75 years
(2 points), diabetes (1 point), stroke/TIA (2 points), vascular
disease (1 point), age 65–74 years (1 point), and sex category
(female; 1 point). The sum of all factors provides the
individual patient’s risk score.
Definition of end points
The primary end point was defined as a hospital diagnosis
of IS, TIA, or TE (peripheral arterial embolism, pulmonary
embolism). IS/TE presents IS, TIA, and TE events combined.
A (...truncated)