<b><i>Background:</i></b> 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 CHA<sub>2</sub>DS<sub>2</sub>-VASc score in a CRT population. <b><i>Methods:</i></b> Data on 796 consecutive CRT patients were retrospectively gathered from hospital records and healthcare registries. CHA<sub>2</sub>DS<sub>2</sub>-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. CHA<sub>2</sub>DS<sub>2</sub>-VASc score was evaluated against the end points with survival analyses and compared to other risk stratification scores. <b><i>Results:</i></b> The CHA<sub>2</sub>DS<sub>2</sub>-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. <b><i>Conclusion:</i></b> When tested for association with outcome in a CRT population, the CHA<sub>2</sub>DS<sub>2</sub>-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.
Morbidity and mortality in heart failure patients treated with cardiac resynchronization therapy: influence of pre-implantation characteristics on long-term outcome
