RCHADS and RCHADSVASc schemes improved the performance of CHADS and CHADSVASc scores in death risk stratification of Chinese older patients with atrial fibrillation.

BACKGROUND

This analysis was carried out to refine the CHADS and CHADSVASc scores by combining creatinine clearance (CrCl) and glomerular filtration rate (GFR) and evaluate the performance of CrCl-based and GFR-based schemes in death risk stratification of Chinese older patients with atrial fibrillation (AF).

METHODS

There were 219 older patients with AF, and all-cause mortality was assessed during the follow-up of 1.11 years. Renal function was evaluated using the CrCl formula and different GFR (Modification of Diet in Renal Disease [MDRD], Chinese MDRD [CMDRD], Mayo Clinic Quadratic [Mayo] and Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]) formulas, and five kinds of RCHADS and RCHADSVASc schemes were generated by combining CrCl and GFR with CHADS and CHADSVASc scores.

RESULTS

In Cox regression multivariate analysis, CrCl <60 mL/min was moderately associated with death risk (=0.122 and =0.144). When MDRD, CMDRD, CKD-EPI and Mayo formulas were used to ascertain the GFR, GFR <60 mL/min/1.73 m was significantly associated with death risk (<0.001 for all). In the models with CHADS and CHADSVASc scores as the linear covariates, CrCl and GFR as the continuous variables were significantly associated with death risk (<0.05 for all). C-statistics of CrCl-based schemes - R2(CrCl)CHADS and R2(CrCl) CHADSVASc - moderately exceeded that of CHADS and CHADSVASc scores (=0.081 and 0.082). C-statistics of GFR-based schemes - RCHADS and RCHADSVASc - significantly exceeded that of CHADS and CHADSVASc scores (<0.05 for all).

CONCLUSION

Chinese older patients with AF with lower levels of GFR and GFR <60 mL/min/1.73 m had a significantly high death risk, and those with lower levels of CrCl or CrCl <60 mL/min had a significantly or modestly high death risk. There was significantly better performance of GFR-based schemes and moderately better performance of CrCl-based schemes in death risk stratification compared with CHADS and CHADSVASc scores.