Prediction of acute coronary syndrome, ischemic stroke, and mortality in patients with heart failure: a comparison of CHADS-VASc and AHEAD scores.

PURPOSE

To compare the predictive capacity of the CHADS-VASc and AHEAD scores in predicting acute coronary syndrome (ACS), ischemic stroke (IS), and mortality in patients with heart failure (HF).

METHODS

A total of 404,635 patients hospitalized for HF between 2000 and 2011 were recruited from a large national database in Taiwan. The predictive value of both scores was evaluated by analysis of the area under the receiver operating characteristic curve (AUROC), and the difference in their discriminative capacity was assessed using the DeLong test.

RESULTS

The AUROC for the CHADS-VASc score was significantly higher than that for the AHEAD score in predicting ACS and IS: 0.53 (95% CI = 0.53-0.54) versus 0.51 (95% CI = 0.51-0.52) for ACS, and 0.57 (95% CI = 0.56-0.57) versus 0.52 (95% CI = 0.51-0.52) for IS, respectively (all DeLong tests p < 0.001). By contrast, for mortality risk, the AUROC was significantly lower for the CHADS-VASc score (0.56, 95% CI = 0.55-0.56) than the AHEAD score (0.60, 95% CI = 0.59-0.60; DeLong test p < 0.001).

CONCLUSIONS

The ability of the CHADS-VASc score to predict macrovascular complications (ACS and IS) in HF patients was higher than that of AHEAD.