CHA₂DS₂-VASc score as a mortality predictor in acute heart failure with preserved ejection fraction

The mortality rate in decompensated heart failure (HF) with preserved ejection fraction (HFpEF) remains high. In recent years the prognostic role of CHA₂DS₂-VASc score, initially formulated for embolic risk prediction in atrial fibrillation, has been shown in other diseases including HF. We sought to analyze a long-term mortality in decompensated HFpEF patients depending on CHA₂DS₂-VASc score.

261 (22.74%) out of 1,148 patients included in the single-center Lesser Poland Cracovian Heart Failure (LECRA-HF) Registry between 2009 and 2022 were diagnosed with decompensated HFpEF. We identified 213 (81.61%) subjects with CHA₂DS₂-VASc score ≥4 points and 48 (18.39%) < 4 points.

Patients with CHA₂DS₂-VASc ≥4 were older (79 vs. 64 years, P < 0.001), mostly females (65.3% vs. 27.1%, P < 0.001), and were characterized by atrial fibrillation (62.9% vs. 31.3%, P < 0.001), prior myocardial infarction (24.4% vs. 6.3%, P = 0.005), percutaneous coronary intervention (23.0% vs. 4.2%, P = 0.003) and coronary artery bypass surgery (11.3% vs. 2.1%, P = 0.049) compared to CHA₂DS₂-VASc <4 cohort. Lower baseline GFR (by 26.7%, P < 0.001), potassium (by 4.4%, P = 0.02), hemoglobin (by 10.3%, P < 0.001), as well as hematocrit (by 8.1%, P = 0.003) were noted in CHA₂DS₂-VASc ≥4 patients. In a long-term follow-up (median 4.3 years), overall mortality was significantly higher in CHA₂DS₂-VASc ≥4 group (P = 0.005) and CHA₂DS₂-VASc ≥4 was its independent predictor (HR 3.54, 95% confidence interval 1.68-7.49). In a multivariable Cox regression analysis, each one-point increase in CHA₂DS₂-VASc score raised all-cause mortality risk by 32%.

As has been shown for the first time CHA₂DS₂-VASc score was an independent prognostic parameter in decompensated HFpEF.