Predicting stroke and death in patients with heart failure using CHA₂DS₂-VASc score in Asia

Area of Science:

• Cardiology
• Clinical Research
• Public Health

Background:

• The CHA2DS2-VASc score is a standard tool for assessing stroke and mortality risk in atrial fibrillation (AF) patients.
• Heart failure (HF) is a condition associated with increased risk of stroke and mortality.
• The predictive value of the CHA2DS2-VASc score in HF patients, particularly in Asian populations, requires further investigation.

Purpose of the Study:

• To evaluate the predictive capability of the CHA2DS2-VASc score for 1- and 2-year risks of stroke and death in Asian patients with heart failure (HF).
• To assess the CHA2DS2-VASc score's performance in stratifying risk among HF patients with and without atrial fibrillation (AF).

Main Methods:

• A prospective observational multicenter cohort study (KorAHF registry) enrolled 5158 hospitalized HF patients.
• Patients with a history of cancer were excluded.
• The CHA2DS2-VASc score's discriminatory properties were assessed using C-statistics.

Main Results:

• The study included 5158 HF patients (2091 with AF, 3067 without AF).
• Stroke rates were higher in patients with AF compared to those without AF at both 1 and 2 years.
• Each 1-point increase in CHA2DS2-VASc score significantly correlated with increased risks of stroke and all-cause death in both HF patient groups (p < 0.05).
• C-statistics for all-cause death ranged from 0.600 to 0.635, and for stroke from 0.593 to 0.639, indicating modest predictive ability.

Conclusions:

• The CHA2DS2-VASc score is significantly associated with stroke and death risks in HF patients, irrespective of AF status.
• The CHA2DS2-VASc score demonstrated only modest predictive power for stroke and death in this cohort.
• Further research into modified risk scores is warranted, and early post-hospitalization stroke prevention in HF patients is essential due to high mortality and early stroke occurrence.