CHADS2 score has a better predictive value than CHA2DS2-VASc score in elderly patients with atrial fibrillation

Yunli Xing, Qing Ma, Xiaoying Ma, Cuiying Wang, Dai Zhang, Ying Sun, Yunli Xing, Qing Ma, Xiaoying Ma, Cuiying Wang, Dai Zhang, Ying Sun

Abstract

Aim: The study aims to compare the ability of CHA2DS2-VASc (defined as congestive heart failure, hypertension, age ≥75 years [two scores], type 2 diabetes mellitus, previous stroke, transient ischemic attack, or thromboembolism [TE] [doubled], vascular disease, age 65-74 years, and sex category) and CHADS2 (defined as congestive heart failure, hypertension, age ≥75 years, type 2 diabetes mellitus, previous stroke [doubled]) scores to predict the risk of ischemic stroke (IS) or TE among patients with nonvalvular atrial fibrillation (NVAF).

Methods: A total of 413 patients with NVAF aged ≥65 years, and not on oral anticoagulants for the previous 6 months, were enrolled in the study. The predictive value of the CHA2DS2-VASc and CHADS2 scores for IS/TE events was evaluated by the Kaplan-Meier method.

Results: During a follow-up period of 1.99±1.29 years, 104 (25.2%) patients died and 59 (14.3%) patients developed IS/TE. The CHADS2 score performed better than the CHA2DS2-VASc score in predicting IS/TE as assessed by c-indexes (0.647 vs 0.615, respectively; P<0.05). Non-CHADS2 risk factors, such as vascular disease and female sex, were not found to be predictive of IS/TE (hazard ratio 1.518, 95% CI: 0.832-2.771; hazard ratio 1.067, 95% CI: 0.599-1.899, respectively). No differences in event rates were found in patients with the CHADS2 scores of 1 and 2 (7.1% vs 7.8%). It was observed that patients with a CHADS2 score of ≥3 were most in need of anticoagulation therapy.

Conclusion: In patients with NVAF aged ≥65 years, the CHADS2 score was found to be significantly better in predicting IS/TE events when compared to the CHA2DS2-VASc score. Patients with a CHADS2 score of ≥3 were associated with high risk of IS/TE events.

Keywords: NVAF; elderly; sex; vascular disease.

Figures

Figure 1
Figure 1
ROC curves of CHADS2 and CHA2DS2-VASc scores in predicting IS/TE. Notes: CHADS2 < congestive heart failure, hypertension, age ≥75 years, type 2 DM, previous stroke (doubled); CHA2DS2-VASc, congestive heart failure, hypertension, age ≥75 years (two scores), type 2 DM, previous stroke, TIA, or TE (doubled), vascular disease, age 65–74 years, and sex category. Abbreviations: DM, diabetes mellitus; IS, ischemic stroke; ROC, receiver operating characteristic; TE, thromboembolism; TIA, transient ischemic attack.
Figure 2
Figure 2
The Kaplan–Meier curve of freedom from ischemic stroke by CHADS2 score. Note: CHADS2 < congestive heart failure, hypertension, age ≥75 years, type 2 DM, previous stroke (doubled). Abbreviation: DM, diabetes mellitus.
Figure 3
Figure 3
Risk of IS/TE based on CHADS2 scores. Note: CHADS2, congestive heart failure, hypertension, age ≥75 years, type 2 DM, previous stroke (doubled). Abbreviations: DM, diabetes mellitus; IS, ischemic stroke; TE, thromboembolism; M–H, Mantel–Haenszel test.

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Source: PubMed

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