CHA2DS2-VASc Score in Heart Failure Patients

Study Questions:

Does the CHA2DS2-VASc score predict ischemic stroke, thromboembolism, and death in a cohort of patients with heart failure (HF) regardless of comorbid atrial fibrillation (AF)?


Using a Danish nationwide prospective cohort registry, 42,987 patients with HF and without anticoagulation treatment were identified between 2000 and 2012; 21.9% of patients had concomitant AF. CHA2DS2-VASc scores were calculated based on a history of congestive heart failure, hypertension, age, diabetes, prior stroke, vascular disease, and gender. The primary outcomes were incident ischemic stroke, thromboembolism, and death within 1 year of HF diagnosis based on ICD-10 (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision) diagnosis or national death database information.


In patients without AF, the risk of ischemic stroke, thromboembolism, and death was 3.1%, 9.9%, and 21.8%, respectively. Risks for all three outcomes increased with increasing CHA2DS2-VASc score. At high CHA2DS2-VASc score (≥4), the absolute risk of thromboembolism was higher among patients without comorbid AF (9.7%) as compared to patients with comorbid AF (9.2%, p < 0.001). Discrimination of the CHA2DS2-VASc score ranged between 0.62-0.67 for all outcomes in populations with and without AF.


The authors concluded that in patients with HF (with or without AF), the CHA2DS2-VASc score was associated with the risks of ischemic stroke, thromboembolism, and death. However, the predictive accuracy was modest, and clinical utility remains to be determined.


The authors used a Danish national registry to explore the predictive ability of the CHA2DS2-VASc score for ischemic stroke, thromboembolism, and death among patients with HF. As the number of thromboembolism risk factors increases (higher CHA2DS2-VASc score), the risks of all three outcomes increase. Although the predictive ability is similarly modest for AF-related thromboembolism as it is for HF-related outcomes, clinical implications of the CHA2DS2-VASc score in AF patients remain unexplored. Future studies will need to explore the utility of preventative therapies (e.g., anticoagulants) in HF patients at high risk for ischemic stroke and thromboembolism.

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