The CHA2DS2-VASc Score and Its Association with Long-Term Outcome in a Cardiac Resynchronization Therapy Population
Christian Reitan1,2,3, Pyotr G Platonov1,4, Rasmus Borgquist1,4
1Department of Cardiology, Institution for Clinical Sciences, Lund University, Lund, Sweden.
Insights
The CHA2DS2-VASc score predicts increased mortality and heart failure hospitalization risk in cardiac resynchronization therapy (CRT) patients. This score performs comparably to existing CRT-specific risk scores, though all scores require cautious application.
Area of Science:
- Cardiology
- Clinical Medicine
- Medical Informatics
Background:
- Cardiac resynchronization therapy (CRT) is a key treatment for heart failure with left ventricular dyssynchrony.
- Predictive scoring systems are crucial for assessing long-term outcomes in CRT patients.
- The CHA2DS2-VASc score, typically used for atrial fibrillation, was evaluated in a CRT cohort.
Purpose of the Study:
- To assess the predictive performance of the CHA2DS2-VASc score in patients undergoing cardiac resynchronization therapy.
- To compare the CHA2DS2-VASc score's efficacy against other established risk stratification tools in this population.
Main Methods:
- Retrospective analysis of 796 consecutive CRT patients' data.
- Calculation of CHA2DS2-VASc scores and comparison with other risk scores.
- Evaluation of outcomes including mortality, heart failure hospitalizations, and composite events using survival analyses.
Main Results:
- CHA2DS2-VASc score showed significant correlation with mortality and heart failure hospitalization risk (unadjusted HRs 1.28 and 1.19, respectively).
- Performance was comparable to other validated scores for mortality (Harrell's C: 0.61) and heart failure hospitalization (Harrell's C: 0.57).
- AUC for 5- and 10-year survival were 0.63 and 0.73, respectively.
Conclusions:
- The CHA2DS2-VASc score is associated with increased mortality and heart failure hospitalization risk in CRT patients.
- Its predictive performance is similar to existing CRT-specific scoring systems.
- Caution is advised when utilizing all tested risk stratification scores in the CRT population.
Background:
Cardiac resynchronization therapy (CRT) is commonly used in patients with heart failure and left ventricular dyssynchrony. Several scoring systems have been tested in order to predict long-term outcome. Although intended for use in patients with atrial fibrillation, we sought to assess the performance of the CHA2DS2-VASc score in a CRT population.
Methods:
Data on 796 consecutive CRT patients were retrospectively gathered from hospital records and healthcare registries. CHA2DS2-VASc scores were calculated, as well as other stratification scores for comparison. The outcomes were crude mortality, time to first heart failure hospitalization, and a composite of the 2. CHA2DS2-VASc score was evaluated against the end points with survival analyses and compared to other risk stratification scores.
Results:
The CHA2DS2-VASc score was significantly correlated with both outcomes in univariable and multivariable analysis adjusting for other known predictors of CRT outcome (unadjusted HR 1.28, 95% CI 1.21-1.36 and HR 1.19, 95% CI 1.13-1.25 for the mortality and heart failure hospitalization end points, respectively). Its performance compared well to other validated scores for the mortality end point (Harrell's C: 0.61, range for other scoring systems: 0.57-0.65), as well as the heart failure hospitalization end point (Harrell's C: 0.57, range of other scoring systems: 0.58-0.62). It correlated to 5- and 10-year survival with an area under the curve of 0.63 and 0.73, respectively.
Conclusion:
When tested for association with outcome in a CRT population, the CHA2DS2-VASc score correlates to increased mortality and risk of heart failure hospitalization. It performs similarly to CRT-specific scores. However, the results of this study indicate that all tested scores should be used with caution in CRT patients.
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