CHA2DS2-VASc scores and Intermountain Mortality Risk Scores for the joint risk stratification of dementia among patients with atrial fibrillation

Kevin G Graves; Heidi T May; Victoria Jacobs; Kirk U Knowlton; Joseph B Muhlestein; Donald L Lappe; Jeffrey L Anderson; Benjamin D Horne; T Jared Bunch

doi:10.1016/j.hrthm.2018.10.018

CHA₂DS₂-VASc scores and Intermountain Mortality Risk Scores for the joint risk stratification of dementia among patients with atrial fibrillation

Heart Rhythm. 2019 Jan;16(1):3-9. doi: 10.1016/j.hrthm.2018.10.018.

Authors

Kevin G Graves¹, Heidi T May², Victoria Jacobs², Kirk U Knowlton², Joseph B Muhlestein³, Donald L Lappe³, Jeffrey L Anderson³, Benjamin D Horne¹, T Jared Bunch⁴

Affiliations

¹ Intermountain Heart Institute, Intermountain Medical Center, University of Utah, Salt Lake City, Utah; Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah.
² Intermountain Heart Institute, Intermountain Medical Center, University of Utah, Salt Lake City, Utah.
³ Intermountain Heart Institute, Intermountain Medical Center, University of Utah, Salt Lake City, Utah; Cardiology Division, Department of Internal Medicine, University of Utah, Salt Lake City, Utah.
⁴ Intermountain Heart Institute, Intermountain Medical Center, University of Utah, Salt Lake City, Utah; Stanford University, Department of Internal Medicine, Palo Alto, California. Electronic address: Thomas.bunch@imail.org.

PMID: 30611392
DOI: 10.1016/j.hrthm.2018.10.018

Abstract

Background: High CHA₂DS₂-VASc scores in atrial fibrillation (AF) patients are generally associated with increased risks of stroke and dementia. At lower CHA₂DS₂-VASc scores, there remains an unquantifiable cranial injury risk, necessitating an improved risk assessment method within these lower-risk groups.

Objective: The purpose of this study was to determine whether sex-specific Intermountain Mortality Risk Scores (IMRS), a dynamic measures of systemic health that comprises commonly performed blood tests, can stratify dementia risk overall and among CHA₂DS₂-VASc score strata in AF patients.

Methods: Female (n = 34,083) and male (n = 39,998) AF patients with no history of dementia were studied. CHA₂DS₂-VASc scores were assessed at the time of AF diagnosis and were stratified into scores of 0-1, 2, and ≥3. Within each CHA₂DS₂-VASc score stratum, patients were further stratified by IMRS categories of low, moderate, and high. Multivariable Cox hazard regression was used to determine dementia risk.

Results: High-risk IMRS patients were generally older and had higher rates of hypertension, diabetes, heart failure, and prior stroke. Higher CHA₂DS₂-VASc score strata (≥3 vs ≤1: women, hazard ratio [HR] 7.77, 95% confidence interval [CI] 5.94-10.17, P < .001; men: HR 4.75, 95% CI 4.15-5.44, P < .001) and IMRS categories (high vs low: women, HR 3.09, 95% CI 2.71-3.51, P < .001; men, HR 2.70, 95% CI 2.39-3.06, P < .001) were predictive of dementia. When stratified by CHA₂DS₂-VASc scores, IMRS further identified risk in each stratum.

Conclusion: Both CHA₂DS₂-VASc scores and IMRS were independently associated with dementia incidence among AF patients. IMRS further stratified dementia risk among CHA₂DS₂-VASc score strata, particularly among those with lower CHA₂DS₂-VASc scores.

Keywords: Atrial fibrillation; Cognition; Dementia; Diabetes; Gender; Heart failure; Hypertension; Risk factors; Stroke.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Age Factors
Aged
Atrial Fibrillation / complications
Atrial Fibrillation / diagnosis*
Atrial Fibrillation / mortality
Dementia / diagnosis
Dementia / epidemiology*
Dementia / etiology
Female
Humans
Incidence
Male
Middle Aged
Risk Assessment / methods*
Risk Factors
Sex Factors
Survival Rate / trends
Thromboembolism / epidemiology*
United States / epidemiology