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CHA2DS2-VASc Score in Patients With Atrial Fibrillation and Cancer: A U.S. Nationwide Study
Mohammad Al Mouslmani1, Mohamad Alhoda Alahmad2, Zafer Akman3
1Department of Hospital Medicine, Yale New Haven Hospital, New Haven, Connecticut.
The American Journal of Cardiology
|April 25, 2025
Summary
The CHA₂DS₂-VASc score predicts stroke risk in atrial fibrillation patients. This study found the score is also associated with stroke in cancer patients, with higher risks observed in this group.
Area of Science:
- Cardiology
- Oncology
- Neurology
Background:
- The CHA₂DS₂-VASc score is standard for atrial fibrillation stroke risk. Its utility in cancer patients is unproven, lacking cancer-specific factors.
- Atrial fibrillation (AF) and malignancy are common comorbidities, increasing cerebrovascular accident (CVA) risk.
Purpose of the Study:
- To assess the CHA₂DS₂-VASc score's association with acute CVA in hospitalized atrial fibrillation patients with and without malignancy.
- To determine if the CHA₂DS₂-VASc score's predictive value for CVA differs between cancer patients and those without cancer.
Main Methods:
- Cross-sectional analysis of the Nationwide Readmissions Database (2016-2019).
- Inclusion of all patients with a primary diagnosis of atrial fibrillation/flutter.
- Stratification into cohorts with and without malignancy, followed by CHA₂DS₂-VASc score calculation and CVA association analysis.
Main Results:
- 1,769,603 AF/flutter admissions identified; 96,982 had malignancy.
- In both cohorts, higher CHA₂DS₂-VASc scores correlated with increased odds of acute CVA during hospitalization.
- The odds ratio for CVA was significantly higher in the malignancy cohort (OR 4.73 for score 2) compared to the non-malignancy cohort (OR 2.61 for score 2).
Conclusions:
- The CHA₂DS₂-VASc score is linearly associated with acute CVA in atrial fibrillation patients, both with and without cancer.
- The elevated odds ratios in cancer patients highlight the critical need for appropriate anticoagulation strategies in this high-risk population.
- Further research may explore incorporating cancer-specific risk factors into risk stratification models for AF patients with malignancy.
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