Arrhythmias and Conduction Disturbances
Usefulness of the CHA2DS2-VASc Score to Predict Mortality in Defibrillator Recipients

https://doi.org/10.1016/j.amjcard.2017.03.257Get rights and content

The CHA2DS2-VASC score is a well-validated stratification tool that predicts the risk of thromboembolism and stroke in patients with nonvalvular atrial fibrillation. Several studies have examined its application as a predictor of mortality in clinical applications other than atrial fibrillation. However, there are current no studies examining its use as an outcome prediction tool in a population of patients with implantable cardiac defibrillators (ICDs). In this study, we examined data from 2,258 patients who underwent ICD device implantation at the hospitals of the University of Pittsburgh Medical Center from February 2002 to April 2014 (median follow-up 5.1 years) and examined the impact of their CHA2DS2-VASC score at the time of device implantation on all-cause mortality. Survival curves based on CHA2DS2-VASC scores were generated using the Kaplan-Meier method and were adjusted for unbalanced covariates using the Cox proportional hazards model. The mean CHA2DS2-VASC score was 3.15 ± 1.52 (range 1 to 8, mode 3). The CHA2DS2-VASC score predicted all-cause mortality in a significant and dose-dependent fashion. Analyzing the population by quartiles revealed increasing all-cause mortality from Q1 to Q4 (p <0.001). Using a Cox multivariate model adjusting for ejection fraction, BMI, serum creatinine, hemoglobin level, and QRS width, the CHA2DS2-VASC score remained a strong predictor of all-cause mortality (hazard ratio 1.26 per 1-point increase, 95% confidence interval 1.20 to 1.32). In conclusion, the CHA2DS2-VASC score is a simple tool that highly predicts all-cause mortality in patients with ICD.

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Methods

The study population consisted of all patients (n = 2,258) who underwent ICD device implantation at the hospitals of the University of Pittsburgh Medical Center from February 2002 to April 2014. Data collection was approved by the Institutional Review Board at the University of Pittsburgh Medical Center. Patients <18 years and those who were implanted with recalled ICD leads were excluded from this analysis. All demographic and clinical data at the time of implantation were extracted from the

Results

A total of 2,258 consecutive patients were included in this analysis. CHA2DS2-VASC scores were calculated based on data at the time of patients' initial operative procedure for ICD implantation. Patients' demographic and clinical data are detailed in Table 1. Over a mean follow-up of 5.4 ± 3.6 years (median 5.1 years), 1,195 patients (53%) died. Total number of patients and mortality outcomes stratified by CHA2DS2-VASC score are listed in Table 2. The mean CHA2DS2-VASC score was 3.15 ± 1.52

Discussion

In this study comprising of a cohort of 2,258 ICD recipients not involved in any device recalls or advisories, we demonstrate that the CHA2DS2-VASC score, well-validated for assessing the risk of thromboembolic events in patients with atrial fibrillation, is also a strong predictor of mortality in ICD recipients. Our findings demonstrate that higher CHA2DS2-VASC scores are associated with increased mortality in ICD recipients, even after controlling for unbalanced covariates between quartile

Disclosures

The authors have no conflicts of interest to disclose.

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    2021, International Journal of Cardiology
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    The CHA2DS2-VASc score has been shown to have a modestly better discriminative ability than the CHADS2 score in AF, especially in lower risk groups [6,7]. CHA2DS2-VASc scores may also predict MACE in patients with other conditions, such as chronic obstructive pulmonary disease [8], those undergoing isolated coronary artery bypass grafting (CABG) surgery [9] or percutaneous coronary intervention [10], with heart failure [11], or with implantable cardiac defibrillators [12]. The Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial demonstrated that the combination therapy of rivaroxaban plus aspirin compared with aspirin reduced the risk of MACE with hazard ratio of 0.76 (95% CI: 0.66–0.86) and mortality with hazard ratio of 0.82 (95% CI: 0.71–0.96) in patients with chronic CAD and/or PAD [13].

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