Stroke risk scores to predict hospitalization for acute decompensated heart failure in atrial fibrillation patients

Area of Science:

• Cardiology
• Clinical Research
• Arrhythmia Management

Background:

• Atrial fibrillation (AF) is a common hospitalized arrhythmia associated with increased risks of mortality, stroke, and heart failure (HF).
• Existing stroke risk scores, such as CHA₂DS₂-VASc, are widely used but their ability to predict HF decompensation in AF patients is not well-established.
• Limited data exists on the predictive performance of stroke risk scores for acute decompensated heart failure hospitalizations in atrial fibrillation populations.

Purpose of the Study:

• To evaluate the predictive capability of established stroke risk scores for hospitalizations due to acute decompensated heart failure (HF) in patients with atrial fibrillation (AF).
• To determine if commonly used risk stratification tools for stroke can identify AF patients at higher risk for HF decompensation.

Main Methods:

• A retrospective observational study was conducted on a cohort of 204 patients admitted for cardiovascular conditions.
• The study analyzed the predictive accuracy of CHADS₂, R₂CHADS₂, and CHA₂DS₂-VASc scores for hospitalizations with acute decompensated HF in AF patients.
• Statistical analyses included C-statistics (AUC), relative risk (RR), and correlation coefficients (r) to assess predictive performance.

Main Results:

• CHADS₂ (AUC 0.631) and R₂CHADS₂ (AUC 0.619) demonstrated modest predictive ability for HF decompensation hospitalizations.
• CHA₂DS₂-VASc showed a marginal correlation (AUC 0.572, p=0.09) and weaker predictive performance compared to CHADS₂ and R₂CHADS₂.
• Higher scores (≥2) for CHADS₂ and R₂CHADS₂ were significantly associated with an increased risk of decompensated HF hospitalization (RR 2.96 and 2.41, respectively).

Conclusions:

• The CHADS₂, R₂CHADS₂, and CHA₂DS₂-VASc scores are associated with the risk of hospitalization for decompensated HF in AF patients.
• While showing some association, the predictive accuracy of these scores for HF decompensation was modest.
• Further research is needed to determine the clinical utility of these stroke risk scores for predicting heart failure decompensation in AF patients.