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Heart failure: a weak link in CHA2 DS2 -VASc

Leif Friberg1,2, Lars H Lund3,4

  • 1Department of Clinical Sciences, Karolinska Institute, Stockholm, Sweden.

ESC Heart Failure
|February 16, 2018
PubMed

Insights

Heart failure is not an independent stroke risk factor in atrial fibrillation patients. The CHA2DS2-VASc score accurately predicts stroke risk without needing a separate heart failure assessment.

Area of Science:

  • Cardiology
  • Neurology
  • Public Health

Background:

  • Stroke risk in atrial fibrillation (AF) is assessed using the CHA2DS2-VASc score.
  • Heart failure (HF) is a component of this score, but its independent contribution to stroke risk is unclear.

Purpose of the Study:

  • To determine if heart failure is an independent risk factor for stroke in patients with atrial fibrillation.
  • To evaluate the impact of heart failure on stroke risk beyond other established CHA2DS2-VASc risk factors.

Main Methods:

  • A large cohort study of 300,839 patients with atrial fibrillation was conducted using the Swedish Patient Register (2005-2011).
  • Three different definitions of heart failure were applied to assess the robustness of findings.
  • Multivariable Cox regression analyses were used to assess associations between heart failure and stroke, adjusting for CHA2DS2-VASc risk factors.

Main Results:

  • Patients with heart failure were older and had a higher CHA2DS2-VASc score compared to those without.
  • The 1-year incidence of ischemic stroke was higher in patients with heart failure before adjustment.
  • After adjusting for CHA2DS2-VASc risk factors, the difference in stroke risk between patients with and without heart failure was eliminated (HR 1.01; 95% CI 0.96-1.05).
  • Adding heart failure to the CHA2DS2-VASc score did not improve its predictive ability for stroke.

Conclusions:

  • Clinical diagnosis of heart failure is not an independent predictor of stroke in atrial fibrillation patients.
  • These findings suggest that current anticoagulation management strategies based on the CHA2DS2-VASc score may not require modification for heart failure.
  • Re-evaluation of heart failure's role in stroke risk stratification for AF patients may be warranted.
Abstract

Keywords:
AnticoagulationAtrial fibrillationEpidemiologyHeart failureRegisterStroke

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