ACC/AHA Hypertension Guideline Impacts CHAD2S2-VASc Up-Scoring in Patients With AFib
CHAD2S2-VASc up-scoring was observed in 63.1% of patients with atrial fibrillation (AFib) by 36 months after first encounter with the hypertension definition introduced by the 2017 ACC/American Heart Association (AHA) hypertension guideline, according to a research letter published recently in JAMA Network Open.
Krishna Pundi, BS, MD, et al., analyzed 316,388 patients (mean age 68 years, 42% women) with AFib captured by the Veradigm Cardiology Registry (formerly the NCDR PINNACLE Registry), including outpatient index encounters on or after Jan. 1, 2016. The study authors compared two definitions of hypertension: Eighth Joint National Committee (JNC 8) hypertension, having two or more blood pressure (BP) measurements with a systolic pressure ≥140 mm Hg and/or diastolic pressure ≥90 mm Hg within a two-year period, and 2017 ACC/AHA hypertension, with BP cutoffs of 130 and 80 mm Hg respectively. They found 17% of patients met the 2017 ACC/AHA hypertension definition at first encounter, of whom 11.9% had a CHAD2S2-VASc score of 0 and 21.2% had a score of 1 before the new hypertension diagnosis.
The primary outcome of the study was CHAD2S2-VASc up-scoring, where patients with an initial score of 0 or 1 received 1 point for hypertension under the 2017 ACC/AHA hypertension definition but not with the JNC 8 hypertension definition. Of 113,359 patients with an initial CHAD2S2-VASc score of 0 or 1, 63.1% had up-scoring by 36 months. Of patients with an index score of 0, 51.4% had JNC 8 hypertension while 86.6% had 2017 ACC/AHA hypertension. Of patients with an index score of 1, 50.0% had JNC 8 hypertension while 83.0% had 2017 ACC/AHA hypertension.
The authors note that among up-scored patients with an initial score of 0 or 1, 48% and 52% were receiving oral anticoagulation within 12 months of up-scoring respectively.
“CHAD2S2-VASc was validated using an older hypertension definition with limited ambulatory BP monitoring and higher BP goals for treatment,” write the study authors. “It is not known if patients with scores of 1 or 2 using the new hypertension definition have sufficient stroke risk to offset the bleeding risk of [oral anticoagulation] and will receive net clinical benefit.”Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Prevention, Anticoagulation Management and Atrial Fibrillation, Atrial Fibrillation/Supraventricular Arrhythmias, Hypertension
Keywords: Stroke, Anticoagulants, Cardiology, Hypertension, Outpatients, American Heart Association, Atrial Fibrillation, Blood Pressure, PINNACLE Registry, National Cardiovascular Data Registries
