CHA2DS2-VASc score predicts risk of thromboembolic events in heart failure patients

Heart failure after first heart attack associated with increased cancer risk

The CHA2DS2-VASc score, which can predict thromboembolic events in heart failure Caucasian patients, has been shown to be effective in stratifying the risk of such events in an Asian population, a new study reports.

Further, including chronic kidney diseases and chronic ischaemic heart diseases improves the predictive power of the CHA2DS2-VASc score.

For the retrospective observational study, information from the Hong Kong Heart Failure Registry was accessed and retrieved. Specifically, patients diagnosed with a new-onset heart failure (delivered between January 2005 to April 2012 and according to the criteria of the Framingham Heart Study) at the Queen Mary Hospital.

The following information were retrieved: echocardiographic findings, laboratory test results, demographic data, clinical presentation, and cardiovascular risk factors. Those who had incomplete data for the follow-up, were below 18 years of age, or were prescribed with anticoagulation agents were excluded from the study.

Myocardial infarction events,which occurred during or before the index hospitalization date, were designated as prior myocardial infarction and were recorded for consideration in the analysis. For the purposes of the study, chronic ischaemic heart disease was defined as myocardial ischaemia as determined by stress testing, or significant coronary artery stenosis as determined by angiography

An estimated glomerular filtration rate of less than 60 ml/min/1.73m2 was defined as a chronic kidney disease as per the Modification of Diet in Renal Disease formula. Finally, the CHA2DS2-VASc scores of the participants were calculated upon diagnosis of heart failure.

The primary outcome of the study was the thromboembolic events, including peripheral thromboembolism, transient ischaemic attack and ischaemic stroke.

From the analysis, it was found that 9.4 percent or 113 individuals, developed thromboembolic events after 36.2±30.1 months. In those that had CHA2DS2-VASc scores of 1, the annual incidence of thromboembolic events was 0.54 percent.

Further, those that had scores of 2 to 3, 4 to 5, and ≥6 showed respective annual incidence rates of thromboembolic events of 1.54, 2.98 and 5.04 percent.

The inclusion of chronic ischaemic heart diseases and chronic kidney diseases improves the predictive power of the CHA2DS2-VASc score, as measured by the area under the Receiver Operating Curve.

Thus, the findings show that the CHA2DS2-VASc can be used to determine the risk of thromboembolic events in heart failure patients, and that adding both chronic ischaemic heart diseases and chronic kidney diseases can further improve the score.