CHA2DS2-VASc score as a predictor of long-term cardiac outcomes in elderly patients with or without atrial fibrillation

Clinical Interventions in Aging, Mar 2018

CHA2DS2-VASc score as a predictor of long-term cardiac outcomes in elderly patients with or without atrial fibrillation Yunli Xing, Ying Sun, Hongwei Li, Mei Tang, Wei Huang, Kan Zhang, Dai Zhang, Deqiang Zhang, Qing Ma Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China 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.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 with and without AF.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. Keywords: CHA2DS2-VASc score, atrial fibrillation, elderly, stroke, survival

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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)


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Yunli Xing, Ying Sun, Hongwei Li, Mei Tang, Wei Huang, Kan Zhang, Dai Zhang, Deqiang Zhang, Qing Ma. CHA2DS2-VASc score as a predictor of long-term cardiac outcomes in elderly patients with or without atrial fibrillation, Clinical Interventions in Aging, 2018, pp. 497-504, DOI: 10.2147/CIA.S147916