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The CHA2DS2-VASc score and Geriatric Multidimensional Assessment tools in elderly patients with persistent atrial

Stefano Fumagalli1, Giulia Pelagalli1, Riccardo Franci Montorzi1

  • 1Geriatric Intensive Care Unit and Geriatric Arrhythmia Unit, University of Florence and AOU Careggi, Florence, Italy.

European Journal of Internal Medicine
|July 26, 2020
PubMed

Insights

The CHA2DS2-VASc score in older adults with atrial fibrillation correlates with cognitive function, depression, and physical health. This score can help assess stroke risk and frailty in elderly patients undergoing cardioversion.

Area of Science:

  • Cardiology
  • Geriatrics
  • Neurology

Background:

  • The CHA2DS2-VASc score is a standard tool for assessing stroke risk in patients with atrial fibrillation (AF).
  • Its utility in elderly populations, particularly concerning geriatric assessments, requires further investigation.
  • Electrical cardioversion (ECV) is a common procedure for restoring sinus rhythm in persistent AF.

Purpose of the Study:

  • To evaluate the association between the CHA2DS2-VASc score and geriatric multidimensional assessment tools in elderly patients undergoing ECV for persistent AF.
  • To determine if the CHA2DS2-VASc score predicts the maintenance of sinus rhythm after ECV in this population.

Main Methods:

  • A cohort of consecutive patients aged 60 years or older undergoing ECV for persistent AF was enrolled.
  • Pre-ECV assessments included the Mini-Mental State Examination (MMSE) for neurocognitive function, the Geriatric Depression Scale (GDS) for depressive symptoms, and the Short Physical Performance Battery (SPPB) for physical functioning.
  • CHA2DS2-VASc scores were calculated, and follow-up assessed for the presence of sinus rhythm.

Main Results:

  • A total of 134 patients (mean age 77±9 years) were included. The mean CHA2DS2-VASc score was 3.8±1.6.
  • Significant correlations were found between the CHA2DS2-VASc score and MMSE (p=0.008), GDS (p<0.001), and SPPB (p<0.001).
  • Higher CHA2DS2-VASc scores were associated with arrhythmia relapse (p=0.048), even after adjusting for amiodarone therapy.

Conclusions:

  • The CHA2DS2-VASc score in elderly patients undergoing ECV is significantly associated with neurocognitive performance, depressive symptoms, and physical functioning.
  • The score also correlates with the risk of AF relapse post-cardioversion.
  • The CHA2DS2-VASc score may serve as a valuable tool for quantifying thromboembolic risk, indicating frailty, and guiding rhythm-control strategies in the elderly AF population.
Abstract

Keywords:
Atrial fibrillationCHA(2)DS(2)-VAScElderlyGeriatric Depression ScaleMini-Mental State ExaminationShort Physical Performance Battery

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