The CHA₂DS₂-VASc Score for Risk Stratification of Stroke in Heart Failure With-vs-Without Atrial Fibrillation

Area of Science:

• Cardiology
• Clinical Research
• Public Health

Background:

• The CHA2DS2-VASc score is established for stratifying stroke risk in atrial fibrillation patients.
• Its utility in heart failure (HF) patients without atrial fibrillation (AF) requires further validation.
• Heart failure is a significant risk factor for thromboembolic events.

Purpose of the Study:

• To externally validate the CHA2DS2-VASc score's ability to risk-stratify heart failure patients for stroke and other adverse outcomes.
• To compare the predictive performance of the CHA2DS2-VASc score in HF patients with and without AF.

Main Methods:

• Retrospective analysis of the national Veteran Affairs database.
• Inclusion of heart failure patients with (n=17,481) and without (n=36,935) atrial fibrillation.
• Utilized Cox proportional models to assess the association between CHA2DS2-VASc score and outcomes, including ischemic stroke, thromboembolism, and death.

Main Results:

• Increasing CHA2DS2-VASc scores correlated with higher incidence rates of stroke, thromboembolism, and death in both HF patient groups (with and without AF).
• The score demonstrated similar predictive ability for stroke in HF patients without AF (C-statistic 0.62) compared to those with AF (C-statistic 0.59).
• Negative predictive values for stroke were high in both groups (85.4% without AF, 86.4% with AF).

Conclusions:

• The CHA2DS2-VASc score is a valuable prognostic tool for heart failure patients, irrespective of atrial fibrillation status.
• Findings support the routine use of the CHA2DS2-VASc score for risk stratification in the broader heart failure population.
• This facilitates improved clinical decision-making and patient management strategies.