Predicting stroke and death in patients with heart failure using CHADS-VASc score in Asia.

BACKGROUND

The CHADS-VASc score is used to assess risk of mortality as well as to stratify risk of stroke in patients with atrial fibrillation (AF). This study evaluated whether CHADS-VASc score was predictive of 1 and 2 year risks of stroke and death in Asian patients with heart failure (HF).

METHODS

Patients hospitalized for HF were enrolled in the Korean Acute Heart Failure (KorAHF) registry, a prospective observational multicenter cohort study, between March 2011 and February 2014. Patients with a history of cancer before hospitalization for HF were excluded. The discriminatory properties of the CHADS-VASc score were quantified using C-statistics.

RESULTS

The study included 5158 patients with HF, 2091 with and 3067 without AF. Rates of stroke in these two groups were 4.5 and 2.8%, respectively, after 1 year, and 5.5 and 3.4%, respectively, after 2 years. Each 1-point increase in CHADS-VASc score was associated with significantly increased risks of stroke and all-cause death in HF patients with and without AF (p-value < 0.05). The C-statistics of the CHADS-VASc score for all-cause death in patients with and without AF were 0.600 and 0.630, respectively, at 1 year and 0.626 and 0.635, respectively, at 2 years. The C-statistics for stroke ranged from 0.593 to 0.639.

CONCLUSIONS

Among patients with incident HF with and without AF, CHADS-VASc score was significantly associated with the risks of stroke and death. However, CHADS-VASc score was only a modest predictor of stroke and death, indicating the need for studies evaluating modified CHADS-VASc scores. The majority of strokes occurred relatively shortly after hospitalization for HF and that mortality rates in patients with HF remain high. Thus, early treatment after HF to prevent stroke is essential.