Efficacy of R2CHA2DS2-VA score for predicting thromboembolism in Thai patients with non-valvular atrial fibrillation

Komsing Methavigul; Poom Sairat; Rungroj Krittayaphong; COOL-AF Investigators

doi:10.1186/s12872-021-02370-2

Efficacy of R₂CHA₂DS₂-VA score for predicting thromboembolism in Thai patients with non-valvular atrial fibrillation

BMC Cardiovasc Disord. 2021 Nov 12;21(1):540. doi: 10.1186/s12872-021-02370-2.

Authors

Komsing Methavigul¹, Poom Sairat², Rungroj Krittayaphong³; COOL-AF Investigators

Affiliations

¹ Department of Cardiology, Central Chest Institute of Thailand, Nonthaburi, Thailand.
² Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
³ Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand. rungroj.kri@mahidol.ac.th.

Abstract

Background: There is no data specific to the addition of renal dysfunction and age 50-64 years as risk parameters to the CHA₂DS₂-VA score, which is known as the R₂CHA₂DS₂-VA score, among NVAF patients. Accordingly, the aim of this study was to validate the R₂CHA₂DS₂-VA score for predicting thromboembolism in Thai NVAF patients.

Methods: Thai NVAF patients were prospectively enrolled in a nationwide multicenter registry from 27 hospitals during 2014-2020. Each component of the CHA₂DS₂-VA and R₂CHA₂DS₂-VA scores was scored and recorded. The main outcomes were thromboembolism, including ischemic stroke, transient ischemic attack (TIA), and/or systemic embolism. The annual incidence rate of thromboembolism among patients in each R₂CHA₂DS₂-VA and CHA₂DS₂-VA risk score category is shown as hazard ratio (HR) and 95% confidence interval (95% CI). The performance of the R₂CHA₂DS₂-VA and CHA₂DS₂-VA scores was demonstrated using c-statistics. Net reclassification index was calculated. Calibration plat was used to assess agreement between observed probabilities and predicted probabilities of both scoring system.

Results: A total of 3402 patients were enrolled during 2014-2020. The average age of patients was 67.38 ± 11.27 years. Of those, 46.9% had renal disease, 30.7% had a history of heart failure, and 17.1% had previous stroke or TIA. The average R₂CHA₂DS₂-VA and CHA₂DS₂-VA scores were 3.92 ± 1.92 and 2.98 ± 1.43, respectively. Annual thromboembolic risk increased with incremental increase in R₂CHA₂DS₂-VA and CHA₂DS₂-VA scores. Oral anticoagulants had benefit in stroke prevention in NVAF patients with an R₂CHA₂DS₂-VA score of 2 or more (adjusted HR: 0.630, 95% CI 0.413-0.962, p = 0.032). The c-statistics were 0.630 (95% CI 0.61-0.65) and 0.627 (95% CI 0.61-0.64), for R₂CHA₂DS₂-VA and CHA2DS2-VA scores respectively. NRI was 2.2%. The slope and R2 of the calibration plot were 0.73 and 0.905 for R₂CHA₂DS₂-VA and 0.70 and 0.846 for CHA₂DS₂-VA score respectively.

Conclusions: R₂CHA₂DS₂-VA score was found to be at least as good as CHA₂DS₂-VA score for predicting thromboembolism in Thai patients with NVAF. Similar to CHA₂DS₂-VA score, thromboembolism increased with incremental increase in R₂CHA₂DS₂-VA score.

Keywords: Anticoagulant; CHA2DS2-VASc; NVAF; Non-valvular atrial fibrillation; R2CHA2DS2-VA; Thromboembolism.

Publication types

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

MeSH terms

Aged
Atrial Fibrillation / complications*
Humans
Middle Aged
Prognosis
Prospective Studies
ROC Curve
Registries
Risk Assessment / methods*
Risk Factors*
Thailand
Thromboembolism / etiology*