Heart failure: a weak link in CHA2 DS2 -VASc.

Abstract

AIMS:

In atrial fibrillation, stroke risk is assessed by the CHA2 DS2 -VASc score. Heart failure is included in CHA2 DS2 -VASc, but the rationale is uncertain. Our objective was to test if heart failure is a risk factor for stroke, independent of other risk factors in CHA2 DS2 -VASc.

METHODS AND RESULTS:

We studied 300 839 patients with atrial fibrillation in the Swedish Patient Register 2005-11. Three definitions of heart failure were used in order to assess the robustness of the results. In the main analysis, heart failure was defined by a hospital discharge diagnosis of heart failure as first or second diagnosis and a filled prescription of a diuretic within 3 months before index + 30 days. The second definition counted first or second discharge diagnoses <1 year before index + 30 days and the third definition any heart failure diagnosis in open or hospital care before index + 30 days. Associations with outcomes were assessed with multivariable Cox analyses. Patients with heart failure were older (80.5 vs. 74.0 years, P < 0.001) and had higher CHA2 DS2 -VASc score (4.4 vs. 2.7, P < 0.001). The 1 year incidence of ischaemic stroke without warfarin was 4.4% with heart failure and 3.1% without. Adjustment for the cofactors in CHA2 DS2 -VASc eradicated the difference in stroke risk between patients with and without heart failure (hazard ratio 1.01 with 95% confidence interval 0.96-1.05). The area under the receiver operating characteristic curve for CHA2 DS2 -VASc was not improved by points for heart failure.

CONCLUSIONS:

A clinical diagnosis of heart failure was not an independent risk factor for stroke in patients with atrial fibrillation, which may have implications for anticoagulation management.

• Authors: Leif Friberg, Lars H Lund
• Journal: ESC heart failure (ESC Heart Fail) Vol. 5 Issue 3 Pg. 231-239 (06 2018) ISSN: 2055-5822 [Electronic] England
• PMID: 29446254 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2018 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

Topics

• Aged
• Aged, 80 and over
• Female
• Follow-Up Studies
• Heart Failure (complications, diagnosis, epidemiology)
• Humans
• Male
• Morbidity (trends)
• Registries
• Retrospective Studies
• Risk Assessment
• Stroke (epidemiology, etiology)
• Survival Rate (trends)
• Sweden (epidemiology)
• Time Factors