Giulia Renda1, Fabrizio Ricci2,3,4, Giuseppe Patti5, Nay Aung6,7, Steffen E Petersen6,7, Sabina Gallina1,2, Viktor Hamrefors3,8, Olle Melander3,8, Richard Sutton9, Gunnar Engstrom3, Raffaele De Caterina10, Artur Fedorowski3,11. 1. Institute of Cardiology, Department of Neuroscience, Imaging and Clinical Sciences, and Center of Excellence on Aging, CeSI-Met, G. d'Annunzio University, Chieti-Pescara, Italy. 2. Institute of Advanced Biomedical Technologies, G. d'Annunzio University, Chieti-Pescara, Italy. 3. Department of Clinical Sciences, Lund University, Malmö, Sweden. 4. Fondazione Villa Serena per la Ricerca, Città Sant'Angelo (PE), Italy. 5. Department of Cardiology, University of L'Aquila, Italy. 6. William Harvey Research Institute, Queen Mary University of London, UK. 7. Barts Heart Centre, St Bartholomew's Hospital, London, UK. 8. Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden. 9. National Heart and Lung Institute, Hammersmith Hospital Campus, London, UK. 10. University Cardiology Division, Pisa University Hospital, Italy. 11. Department of Cardiology, Skåne University Hospital, Malmö, Sweden.
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 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.
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.
Authors: Gabriella Bufano; Francesco Radico; Carolina D'Angelo; Francesca Pierfelice; Maria Vittoria De Angelis; Massimiliano Faustino; Sante Donato Pierdomenico; Sabina Gallina; Giulia Renda Journal: Front Cardiovasc Med Date: 2022-04-25
Authors: Michiel H F Poorthuis; Nicholas R Jones; Paul Sherliker; Rachel Clack; Gert J de Borst; Robert Clarke; Sarah Lewington; Alison Halliday; Richard Bulbulia Journal: Eur J Prev Cardiol Date: 2021-05-22 Impact factor: 8.526
Authors: Giuseppe Patti; Veronica Lio; Giuseppe Di Martino; Fabrizio Ricci; Giulia Renda; Olle Melander; Gunnar Engström; Viktor Hamrefors; Raffaele De Caterina; Artur Fedorowski Journal: Eur J Clin Invest Date: 2021-05-07 Impact factor: 4.686