CHA2DS2-VASc score stratifies mortality risk in patients with and without atrial fibrillation

Abstract

Objectives: The CHA₂DS₂-VASc score is the preferred risk model for anticoagulation decision-making in atrial fibrillation (AF) patients. Recent studies have found this score to have prognostic value in other cardiovascular diseases. We assessed the relationships between CHA₂DS₂-VASc score and long-term mortality in adults referred for stress testing, METHODS: 165 184 consecutive patients from January 1991 to December 2014 from a prospective registry were studied, with CHA₂DS₂-VASc score calculated for all patients, and AF and anticoagulation status were recorded. The primary endpoint was all-cause mortality.

Results: In this cohort, 12 450 (7.5%) patients had AF and mean CHA₂DS₂-VASc score was 2.2±1.2. There were 22 152 (18.4%) deaths during mean follow-up of 6.1±4.8 years. In multivariable analysis, CHA₂DS₂-VASc score, presence of AF and anticoagulation use, along with end-stage renal failure and smoking were all independently associated with mortality with HRs (95% CIs) of 1.23 (1.21 to 1.25), 1.18 (1.10 to 1.27) and 1.50 (1.40 to 1.60), respectively. Higher CHA₂DS₂-VASc score was incrementally associated with worse survival both in patients with and without AF (log-rank p<0.001). Anticoagulation use was associated with reduced survival in non-AF patients with alternative anticoagulation indications at all CHA₂DS₂-VASc score categories, and AF patients with lower CHA₂DS₂-VASc score 0-2, but was protective in AF patients with higher CHA₂DS₂-VASc score 4-9.

Conclusion: Incrementally higher CHA2DS2-VASc score, a simple clinical tool, is associated with mortality in patients regardless of presence of AF and anticoagulation status. Anticoagulation use was associated with worse survival in non-AF patients and AF patients with low CHA₂DS₂-VASc scores, but was protective in AF patients with high CHA₂DS₂-VASc scores.

Keywords: CHA2DS2-VASc score; anticoagulation; atrial fibrillation; exercise test; mortality.