Value of the CHA₂ DS₂ -VASc score for predicting outcome in patients with heart failure

Comorbidities are highly prevalent in patients with heart failure (HF) and affect clinical outcome. The CHA₂ DS₂ -VASc score is a validated score to estimate assessment of thromboembolic risk in patients with atrial fibrillation.

We evaluated the predictive value of this score on clinical outcome in patients with HF. All patients with a diagnosis of chronic HF at a health maintenance organization were evaluated for the CHA₂ DS₂ -VASc score. Patients were followed for cardiac related hospitalizations and death. The cohort included 7106 HF patients. Mean follow-up was 744 days; the median CHA₂ DS₂ -VASc score was 5.0 (range 4.0-6.0). The CHA₂ DS₂ -VASc score was a significant predictor of survival and predictive of the combined end point of death and cardiovascular hospitalization. Survival rates were reduced with increasing quintiles of the CHA₂ DS₂ -VASc score: 93.6 ± 0.7% vs. 83.0 ± 1.1% vs. 75.7 ± 1.0% vs. 73.0 ± 1.2% vs. 63.3 ± 1.2%, respectively P < 0.001. After adjustment for other significant predictors, increasing CHA₂ DS₂ -VASc scores were independently predictive of survival and of the combined end point of death and cardiovascular hospitalization by Cox regression analysis. Analysing the CHA₂ DS₂ -VASc score as a continuous parameter by cox regression analysis demonstrated a significant increase with each point increase in the CHA₂ DS₂ -VASc score (hazard ratio 1.21, 95% confidence interval 1.17-1.26, P < 0.0001). Cox regression analysis using restricted cubic splines demonstrated an independent continuous increase in mortality with increasing CHA₂ DS₂ -VASc score (P < 0.0001 adjusted linear model). The predictive value was present in HF with reduced as well as preserved ejection fraction.

The CHA₂ DS₂ -VASc score has a significant impact on outcome in HF patients.