Background:
Atrial fibrillation (AF) is common in patients with heart failure (HF). CHA2DS2-VASc score is an originally risk assessment tool for stroke in patients with AF. Recently, it has been reported that CHA2DS2-VASc score is associated with mortality in patients with acute coronary syndrome with or without AF. We aimed to examine the value of the CHA2DS2-VASc score as a risk assessment tool in patients with HF. Methods and Results: Consecutive 1011 patients admitted for treatment of HF were divided into three groups based on CHA2DS2-VASc score: low score group (CHA2DS2-VASc score 1-3, n=316), moderate score group (CHA2DS2-VASc score 4-6, n=549) and high score group (CHA2DS2-VASc score 7-9, n=145). Of 1011 HF patients, 387 (38.3%, mean age 70.5 years, male 247) had AF. We compared patient characteristics and prospectively followed all-cause mortality among the three groups. The high score group, as compared to low and moderate score groups, had higher cardio-ankle vascular index (9.0 vs. 8.5, 7.9, P=0.001), lower levels of hemoglobin (11.2 vs. 12.1, 13.4 g/dl, P<0.001), sodium (138.5 vs. 138.4, 139.4 mEq/l, P=0.002) and estimated GFR (40.0 vs. 52.7, 64.3 ml/min/1.73m
2
, p<0.001). In contrast, left ventricular ejection fraction was similar among the three groups. Importantly, all-cause mortality was higher in high score group than in low and moderate score groups (P<0.001). In the multivariable Cox proportional hazard analyses, CHA2DS2-VASc score was an independent predictor of all-cause mortality (all patients: HR 1.203, P<0.001; AF patients: HR 1.152, P=0.009; non-AF patients: HR 1.228, P<0.001). Conclusions: The CHA2DS2-VASc score was an independent predictor of all-cause mortality in HF patients with or without AF. CHA2DS2-VASc score may help to identify patients at high risk for mortality and need for optimization of risk-reducing treatment in HF patients.
Screening for Heart Failure in Diabetes: A Way to Reduce Its Prevalence? A Proof of Concept of a Risk Assessment Tool
