Siqin Ye1, Min Qian2, Bo Zhao2, Richard Buchsbaum2, Ralph L Sacco3, Bruce Levin2, Marco R Di Tullio4, Douglas L Mann5, Patrick M Pullicino6, Ronald S Freudenberger7, John R Teerlink8, J P Mohr9, Susan Graham10, Arthur J Labovitz11, Conrado J Estol12, Dirk J Lok13, Piotr Ponikowski14, Stefan D Anker15, Gregory Y H Lip16, John L P Thompson2, Shunichi Homma4. 1. Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA. sy2357@cumc.columbia.edu. 2. Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA. 3. Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA. 4. Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA. 5. Department of Medicine, Washington University, St. Louis, MO, USA. 6. Kent Institute of Medicine and Health Sciences, University of Kent, Canterbury, UK. 7. Division of Cardiology, Department of Medicine, Lehigh Valley Hospital, Allentown, PA, USA. 8. Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, CA, USA. 9. Department of Neurology, Columbia University Medical Center, New York, NY, USA. 10. Division of Cardiology, Department of Medicine, SUNY Upstate Medical University, Buffalo, NY, USA. 11. Department of Cardiovascular Medicine, University of South Florida, Tampa, FL, USA. 12. Centro Neurológico de Tratamiento y Rehabilitación, Buenos Aires, Argentina. 13. Department of Cardiology, Deventer Hospital, Deventer, The Netherlands. 14. Department of Heart Diseases, Wroclaw Medical University, Military Hospital, Wroclaw, Poland. 15. Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Centre Göttingen, Göttingen, Germany. 16. University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.
Abstract
AIMS: The aim of this study was to determine whether the CHA2 DS2 -VASc score can predict adverse outcomes such as death, ischaemic stroke, and major haemorrhage, in patients with systolic heart failure in sinus rhythm. METHODS AND RESULTS:CHA2 DS2 -VASc scores were calculated for 1101 patients randomized towarfarin and 1123 patients randomized to aspirin. Adverse outcomes were defined as death or ischaemic stroke, death alone, ischaemic stroke alone, and major haemorrhage. Using proportional hazards models, we found that each 1-point increase in the CHA2 DS2 -VASc score was associated with increased hazard of death or ischaemic stroke events [hazard ratio (HR) for the warfarin arm = 1.21, 95% confidence interval (CI) 1.13-1.30, P < 0.001; for aspirin, HR = 1.20, 95% CI 1.11-1.29, P < 0.001]. Similar increased hazards for higher CHA2 DS2 -VASc scores were observed for death alone, ischaemic stroke alone, and major haemorrhage. Overall performance of the CHA2 DS2 -VASc score was assessed using c-statistics for full models containing the risk score, treatment assignment, and score-treatment interaction, with the c-statistics for the full models ranging from 0.57 for death to 0.68 for major haemorrhage. CONCLUSIONS: The CHA2 DS2 -VASc score predicted adverse outcomes in patients with systolic heart failure in sinus rhythm, with modest prediction accuracy.
RCT Entities:
AIMS: The aim of this study was to determine whether the CHA2 DS2 -VASc score can predict adverse outcomes such as death, ischaemic stroke, and major haemorrhage, in patients with systolic heart failure in sinus rhythm. METHODS AND RESULTS: CHA2 DS2 -VASc scores were calculated for 1101 patients randomized to warfarin and 1123 patients randomized to aspirin. Adverse outcomes were defined as death or ischaemic stroke, death alone, ischaemic stroke alone, and major haemorrhage. Using proportional hazards models, we found that each 1-point increase in the CHA2 DS2 -VASc score was associated with increased hazard of death or ischaemic stroke events [hazard ratio (HR) for the warfarin arm = 1.21, 95% confidence interval (CI) 1.13-1.30, P < 0.001; for aspirin, HR = 1.20, 95% CI 1.11-1.29, P < 0.001]. Similar increased hazards for higher CHA2 DS2 -VASc scores were observed for death alone, ischaemic stroke alone, and major haemorrhage. Overall performance of the CHA2 DS2 -VASc score was assessed using c-statistics for full models containing the risk score, treatment assignment, and score-treatment interaction, with the c-statistics for the full models ranging from 0.57 for death to 0.68 for major haemorrhage. CONCLUSIONS: The CHA2 DS2 -VASc score predicted adverse outcomes in patients with systolic heart failure in sinus rhythm, with modest prediction accuracy.
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