Chen Yung-Lung, Cheng Ching-Lan, Huang Jin-Long, Yang Ning-I, Chang Heng-Chia, Chang Kuan-Cheng, Sung Shih-Hsien, Shyu Kou-Gi, Wang Chun-Chieh, Yin Wei-Hsian, Lin Jiunn-Lee, Chen Shyh-Ming
Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City Chang Gung University College of Medicine Department of Pharmacy and Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University Cardiovascular Center, Taichung Veterans General Hospital, Taichung Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung Division of Cardiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City Graduate Institute of Biomedical Sciences, China Medical University Division of Cardiovascular Medicine, China Medical University Hospital, Taichung Division of Cardiology, Taipei Veterans General Hospital Division of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei Division of Cardiology, Chang Gung Memorial Hospital, Linkou Heart Center, Cheng Hsin General Hospital Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China.
Medicine (Baltimore). 2017 Oct;96(43):e8338. doi: 10.1097/MD.0000000000008338.
The CHADS2, CHA2DS2-VASc, and R2CHADS2 scores are well-known predictors of stroke caused by atrial fibrillation (AF), but no studies have evaluated their use for stratifying all-cause mortality risk in patients discharged for systolic heart failure (SHF) with or without AF.This study analyzed data in the Taiwan Society of Cardiology-heart failure with reduced ejection fraction (TSOC-HFrEF) registry. These data were obtained by a prospective, multicenter, observational survey of patients treated at 21 medical centers in Taiwan after hospitalization for acute, pre-existing or new onset SHF from May, 2013 to October, 2014. During 1 year follow-up, 198 patients were lost follow-up, and final 1311 (86.8%) patients were included for further analysis. During the follow-up period, 250 (19%) patients died. Multivariate analysis revealed that body mass index, thyroid disorder, valvular surgery history, chronic kidney disease (CKD), and scores for CHADS2, CHA2DS2-VASc, and R2CHADS2 were significant independent predictors of mortality in the overall population of SHF patients (all P < .05) The c-indexes showed that CHADS2, CHA2DS2-VASc, and R2CHADS2 scores were significantly associated with mortality in SHF patients with or without AF (all P < 005). However, R2CHADS2 had significantly higher accuracy in predicting mortality in all SHF patients compared with CHADS2 and CHA2DS2-VASc (DeLong test, P < .0001), especially in SHF without AF (DeLong test, P = .0003).Scores for CHADS2, CHA2DS2-VASc, and R2CHADS2 can be used to predict 1-year all-cause mortality in SHF patients with or without AF. For predicting all-cause mortality in SHF patients, R2CHADS2 is more accurate than CHADS2 and CHA2DS2-VASc.
CHADS2、CHA2DS2-VASc和R2CHADS2评分是心房颤动（AF）所致卒中的著名预测指标，但尚无研究评估其用于对伴或不伴AF的收缩性心力衰竭（SHF）出院患者的全因死亡风险进行分层的情况。本研究分析了台湾心脏病学会射血分数降低的心力衰竭（TSOC-HFrEF）注册研究中的数据。这些数据通过对2013年5月至2014年10月在台湾21家医疗中心因急性、既往存在或新发SHF住院治疗的患者进行前瞻性、多中心、观察性调查获得。在1年随访期间，198例患者失访，最终纳入1311例（86.8%）患者进行进一步分析。在随访期间，250例（19%）患者死亡。多变量分析显示，体重指数、甲状腺疾病、瓣膜手术史、慢性肾脏病（CKD）以及CHADS2、CHA2DS2-VASc和R2CHADS2评分是SHF患者总体人群中死亡的显著独立预测因素（所有P<0.05）。c指数显示，CHADS2、CHA2DS2-VASc和R2CHADS2评分与伴或不伴AF的SHF患者的死亡率显著相关（所有P<0.005）。然而，与CHADS2和CHA2DS2-VASc相比，R2CHADS2在预测所有SHF患者的死亡率方面具有显著更高的准确性（DeLong检验，P<0.0001），尤其是在不伴AF的SHF患者中（DeLong检验，P=0.0003）。CHADS2、CHA2DS2-VASc和R2CHADS2评分可用于预测伴或不伴AF的SHF患者的1年全因死亡率。对于预测SHF患者的全因死亡率，R2CHADS2比CHADS2和CHA2DS2-VASc更准确。
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