CHA₂ DS₂ -VASc score and adverse outcomes in patients with heart failure with reduced ejection fraction and sinus...

Area of Science:

• Cardiology
• Clinical Medicine
• Risk Stratification

Background:

• Systolic heart failure (SHF) patients in sinus rhythm are at risk for thromboembolic and bleeding events.
• Accurate risk stratification is crucial for guiding therapeutic decisions in these patients.

Purpose of the Study:

• To evaluate the predictive capability of the CHA2DS2-VASc score for adverse outcomes in patients with SHF and sinus rhythm.
• To assess the score's ability to predict death, ischemic stroke, and major hemorrhage.

Main Methods:

• A cohort of 1101 patients on warfarin and 1123 on aspirin with SHF in sinus rhythm were analyzed.
• CHA2DS2-VASc scores were calculated, and adverse outcomes (death, ischemic stroke, major hemorrhage) were recorded.
• Proportional hazards models and c-statistics were used to assess prediction accuracy.

Main Results:

• Each 1-point increase in CHA2DS2-VASc score significantly increased the hazard of death or ischemic stroke (HR 1.20-1.21, P < 0.001).
• Higher scores were also associated with increased risk of death alone, ischemic stroke alone, and major hemorrhage.
• The CHA2DS2-VASc score showed modest predictive performance, with c-statistics ranging from 0.57 for death to 0.68 for major hemorrhage.

Conclusions:

• The CHA2DS2-VASc score is a valuable tool for predicting adverse outcomes in patients with systolic heart failure and sinus rhythm.
• While demonstrating predictive ability, the score's accuracy for these outcomes is modest, suggesting potential for refinement or complementary assessment tools.