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Published on: February 26, 2013
CHADS2 score has a better predictive value than CHA2DS2-VASc score in elderly patients with atrial fibrillation
Yunli Xing1, Qing Ma1, Xiaoying Ma1
1Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
Insights
The CHADS2 score better predicts ischemic stroke (IS) or thromboembolism (TE) in nonvalvular atrial fibrillation (NVAF) patients aged over 65 than CHA2DS2-VASc. Patients with CHADS2 scores of 3 or higher require anticoagulation.
Area of Science:
- Cardiology
- Neurology
- Geriatrics
Background:
- Nonvalvular atrial fibrillation (NVAF) increases the risk of ischemic stroke (IS) and thromboembolism (TE).
- Risk stratification scores are crucial for guiding anticoagulation therapy in NVAF patients.
- CHA2DS2-VASc and CHADS2 scores are commonly used to assess this risk.
Purpose of the Study:
- To compare the predictive accuracy of the CHA2DS2-VASc and CHADS2 scores for IS/TE events in patients with NVAF.
- To identify which score is superior in stratifying stroke risk in this population.
Main Methods:
- A cohort of 413 NVAF patients aged ≥65 years, not on anticoagulants, was studied.
- The Kaplan-Meier method was used to evaluate the predictive performance of both scores.
- Follow-up was conducted to record IS/TE events and mortality.
Main Results:
- During follow-up (1.99±1.29 years), 14.3% of patients experienced IS/TE events.
- The CHADS2 score demonstrated superior predictive ability (c-index 0.647) compared to CHA2DS2-VASc (c-index 0.615; P<0.05).
- Vascular disease and female sex did not significantly predict IS/TE events in this cohort.
Conclusions:
- The CHADS2 score is a more effective tool than CHA2DS2-VASc for predicting IS/TE in NVAF patients aged ≥65.
- Patients with a CHADS2 score of 3 or higher face a significantly elevated risk of IS/TE events and warrant anticoagulation therapy.
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.
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