CHA2DS2VASc score and adverse outcomes in middle-aged individuals without atrial fibrillation
Renda, Giulia ; Ricci, Fabrizio LU ; Patti, Giuseppe ; Aung, Nay ; Petersen, Steffen E ; Gallina, Sabina ; Hamrefors, Viktor LU
; Melander, Olle
LU
; Sutton, Richard
and Engstrom, Gunnar
LU
, et al.
(2019)
In European Journal of Preventive Cardiology
26(18).
p.1987-1997
- Abstract
AIMS: The CHA2DS2VASc score is used to evaluate the risk of thromboembolic events in patients with non-valvular atrial fibrillation. We assessed the prognostic yield of CHA2DS2VASc for new-onset atrial fibrillation, cardiovascular morbidity and mortality in a non-atrial fibrillation population.
METHODS: We analysed a population-based cohort of 22,179 middle-aged individuals with (n = 3542) and without (n = 18,367) a history of atrial fibrillation; we grouped the population into five CHA2DS2VASc strata (0-1-2-3-≥4), and compared the risk of major adverse cerebro-cardiovascular events and mortality. Furthermore, we analysed the annual incidence of atrial fibrillation across different CHA2DS2VASc strata.
RESULTS: Over a median... (More)
AIMS: The CHA2DS2VASc score is used to evaluate the risk of thromboembolic events in patients with non-valvular atrial fibrillation. We assessed the prognostic yield of CHA2DS2VASc for new-onset atrial fibrillation, cardiovascular morbidity and mortality in a non-atrial fibrillation population.
METHODS: We analysed a population-based cohort of 22,179 middle-aged individuals with (n = 3542) and without (n = 18,367) a history of atrial fibrillation; we grouped the population into five CHA2DS2VASc strata (0-1-2-3-≥4), and compared the risk of major adverse cerebro-cardiovascular events and mortality. Furthermore, we analysed the annual incidence of atrial fibrillation across different CHA2DS2VASc strata.
RESULTS: Over a median follow-up of 15 years, 1572 patients (6.9%) had ischaemic strokes, 2162 (9.5%) coronary events and 5899 (26%) died. The cumulative incidence of ischaemic stroke in CHA2DS2VASc ≥ 4 subjects without atrial fibrillation was similar to patients with atrial fibrillation and CHA2DS2VASc 2, with a 10-year crude incidence rate of 0.91 (95% confidence interval (CI) 0.68-1.19) and 1.13 (95% CI 0.93-1.36) ischaemic strokes per 100 patient-years, respectively. CHA2DS2VASc in a non-atrial fibrillation population showed higher predictive accuracy for ischaemic stroke compared with an atrial fibrillation population (area under the curve 0.60 vs. 0.56; P = 0.001). In multivariable Cox regression analysis, CHA2DS2VASc ≥ 2 was an independent predictor of all-cause death (adjusted hazard ratio (aHR) 2.58; 95% CI 2.42-2.76), cardiovascular death (aHR 3.40; 95% CI 2.98-3.89), ischaemic stroke (aHR 2.20; 95% CI 1.92-2.53) and coronary events (aHR 1.83; 95% CI 1.63-2.04). The cumulative incidence of atrial fibrillation was greater with increasing CHA2DS2VASc strata, with an absolute annual incidence of more than 2% per year if CHA2DS2VASc ≥ 4.
CONCLUSION: The CHA2DS2VASc score is a sensitive tool for predicting new-onset atrial fibrillation and adverse outcomes in subjects both with and without atrial fibrillation.
(Less)
- author
- Renda, Giulia
; Ricci, Fabrizio
LU
; Patti, Giuseppe
; Aung, Nay
; Petersen, Steffen E
; Gallina, Sabina
; Hamrefors, Viktor
LU
; Melander, Olle
LU
; Sutton, Richard
and Engstrom, Gunnar
LU
, et al. (More)
- Renda, Giulia
; Ricci, Fabrizio
LU
; Patti, Giuseppe
; Aung, Nay
; Petersen, Steffen E
; Gallina, Sabina
; Hamrefors, Viktor
LU
; Melander, Olle
LU
; Sutton, Richard
; Engstrom, Gunnar
LU
; Caterina, Raffaele De
and Fedorowski, Artur
LU
(Less)
- organization
- publishing date
- 2019-08-14
- type
- Contribution to journal
- publication status
- published
- subject
- in
- European Journal of Preventive Cardiology
- volume
- 26
- issue
- 18
- pages
- 1987 - 1997
- publisher
- Oxford University Press
- external identifiers
-
- pmid:31409109
- scopus:85071429576
- ISSN
- 2047-4881
- DOI
- 10.1177/2047487319868320
- language
- English
- LU publication?
- yes
- id
- 870c2f46-66a7-42b7-84dc-32c9f44a2912
- date added to LUP
- 2019-08-22 07:44:38
- date last changed
- 2024-04-16 17:36:40
@article{870c2f46-66a7-42b7-84dc-32c9f44a2912,
abstract = {{<p>AIMS: The CHA2DS2VASc score is used to evaluate the risk of thromboembolic events in patients with non-valvular atrial fibrillation. We assessed the prognostic yield of CHA2DS2VASc for new-onset atrial fibrillation, cardiovascular morbidity and mortality in a non-atrial fibrillation population.</p><p>METHODS: We analysed a population-based cohort of 22,179 middle-aged individuals with (n = 3542) and without (n = 18,367) a history of atrial fibrillation; we grouped the population into five CHA2DS2VASc strata (0-1-2-3-≥4), and compared the risk of major adverse cerebro-cardiovascular events and mortality. Furthermore, we analysed the annual incidence of atrial fibrillation across different CHA2DS2VASc strata.</p><p>RESULTS: Over a median follow-up of 15 years, 1572 patients (6.9%) had ischaemic strokes, 2162 (9.5%) coronary events and 5899 (26%) died. The cumulative incidence of ischaemic stroke in CHA2DS2VASc ≥ 4 subjects without atrial fibrillation was similar to patients with atrial fibrillation and CHA2DS2VASc 2, with a 10-year crude incidence rate of 0.91 (95% confidence interval (CI) 0.68-1.19) and 1.13 (95% CI 0.93-1.36) ischaemic strokes per 100 patient-years, respectively. CHA2DS2VASc in a non-atrial fibrillation population showed higher predictive accuracy for ischaemic stroke compared with an atrial fibrillation population (area under the curve 0.60 vs. 0.56; P = 0.001). In multivariable Cox regression analysis, CHA2DS2VASc ≥ 2 was an independent predictor of all-cause death (adjusted hazard ratio (aHR) 2.58; 95% CI 2.42-2.76), cardiovascular death (aHR 3.40; 95% CI 2.98-3.89), ischaemic stroke (aHR 2.20; 95% CI 1.92-2.53) and coronary events (aHR 1.83; 95% CI 1.63-2.04). The cumulative incidence of atrial fibrillation was greater with increasing CHA2DS2VASc strata, with an absolute annual incidence of more than 2% per year if CHA2DS2VASc ≥ 4.</p><p>CONCLUSION: The CHA2DS2VASc score is a sensitive tool for predicting new-onset atrial fibrillation and adverse outcomes in subjects both with and without atrial fibrillation.</p>}},
author = {{Renda, Giulia and Ricci, Fabrizio and Patti, Giuseppe and Aung, Nay and Petersen, Steffen E and Gallina, Sabina and Hamrefors, Viktor and Melander, Olle and Sutton, Richard and Engstrom, Gunnar and Caterina, Raffaele De and Fedorowski, Artur}},
issn = {{2047-4881}},
language = {{eng}},
month = {{08}},
number = {{18}},
pages = {{1987--1997}},
publisher = {{Oxford University Press}},
series = {{European Journal of Preventive Cardiology}},
title = {{CHA2DS2VASc score and adverse outcomes in middle-aged individuals without atrial fibrillation}},
url = {{http://dx.doi.org/10.1177/2047487319868320}},
doi = {{10.1177/2047487319868320}},
volume = {{26}},
year = {{2019}},
}