CHA2DS2-VASc scores predict mortality after hospitalization for atrial fibrillation
Introduction
Atrial fibrillation (AF) has reached epidemic proportions. Over the past 2 decades, the incidence of AF has risen by more than 10% and is projected to increase 2.5-fold by the year 2050 [1], [2]. AF is a known independent risk factor for stroke and heart failure. According to data from the Framingham study, AF was associated with a 1.5- to 1.9-fold mortality risk after adjusting for other related cardiovascular conditions [3].
The number of AF hospitalizations has been steadily increasing in several countries. Data from national databases in the United States [4], Denmark [5], and Scotland [6] all revealed at least a 2-fold increase in hospitalization for AF over the past 2 decades. Although several studies have shown improved outcomes in patients admitted with AF [5], [6], a large community-based cohort found that over the past 2 decades, the mortality rates for patients with newly diagnosed AF have not changed significantly [7].
One of the core aspects of AF management is the prevention of thromboembolism. The CHA2DS2-VASc score (congestive heart failure; hypertension; age ≥ 75 years [doubled]; diabetes; previous stroke, transient ischemic attack, or thromboembolism [doubled]; vascular disease; age 65 to 75 years; and sex category) is currently the recommended tool for assessing the risk for thromboembolism among non-valvular AF patients [8], [9]. The scores were also shown to be related to cardiovascular hospitalization, stroke recurrence, and mortality in different population groups [10], [11], [12].
In this present study, we evaluated the mortality rate and associated risk factors following hospitalization for AF in Thailand. We hypothesized that the CHA2DS2-VASc score would predict mortality after AF hospitalization.
Section snippets
Data source
In Thailand, 3 major health benefits are offered to citizens: the civil servant medical benefit scheme (CSMBS), compulsory social security scheme (SSS), and universal health coverage (UHC). Government officers and their families are eligible for CSMBS, while non-government employees and their families are eligible for SSS. Those who do not enroll in CSMBS or SSS are eligible for UHC. The data collected from citizens enrolled in CSMBS and UHC are monitored by the Ministry of Public Health and
Results
The incidence of hospitalization for AF among the total population, UHC insurers, and the CSMBS insurers was 15.5, 15.4 and 26.4 per 100,000 person-years, respectively. Only 14 patients (0.2%) had a prior history of AF (Table 1). The two most common comorbidities were hypertension (N = 1638, 18.2%) and diabetes (N = 1349, 15.0%). Rheumatic heart disease was present in 628 patients (7.0%). The average CHA2DS2-VASc score for all patients was 1.8. Patients stayed in the hospital for an average of 3
Discussion
In this large national database of 8981 patients hospitalized for AF, the mortality rates after the index hospitalization were 18%, 32%, and 44% at 1 year, 3 years, and at the end of the follow-up (46 months), respectively. By utilizing the CHA2DS2-VASc scoring system, the mortality rate was shown to be independently and directly correlated with the scores. The risk of dying increased approximately 1.5-fold in the patients with CHA2DS2-VASc 2–5 and 2-fold in those with scores ≥ 6.
The mortality rate
Conclusion
Mortality after hospitalization for AF is relatively high. The CHA2DS2-VASc score is a strong and independent predictor of death after hospitalization for AF.
Funding
This work was supported by the Thai Society of Atherosclerosis [101/2554], the project of Higher Education Research Promotion and National Research University Development, Office of the Higher Education Commission, Ministry of Education, Thailand [2554], and Pfizer International Co. Ltd [WS2040857]. The authors had full access to the data and take full responsibility for its integrity. All authors have read and approved the final manuscript.
Conflict of interest
None declared.
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Risk stratification of patients with atrial fibrillation in the emergency department
2020, American Journal of Emergency MedicineCitation Excerpt :In the study of both outcomes, the CHA2DS2-VASc score consistently performed the worst, which could be explained by the fact that its design was to predict stroke risk rather than composite adverse events or mortality. However, there have been several studies proposing the use of the CHA2DS2-VASc score to predict mortality and other adverse events apart from stroke or thromboembolism [35,36]. In the study by Larsen, it was found that at 5-year follow-up, the c-index of the CHA2DS2-VASc score for predicting mortality was 0.63 (95% CI = 0.59–0.67) [37], similar to that of our study findings for 90-day mortality.
CHA<inf>2</inf>DS<inf>2</inf>-VASc Score and In-Hospital Mortality in Critically Ill Patients With New-Onset Atrial Fibrillation
2020, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :Among those patients who underwent cardiac resynchronization therapy, the CHA2DS2-VASc score also predicted hospitalization for heart failure and death.23 Furthermore, the CHA2DS2-VASc score was also predictive of hospitalization as well as mortality after hospitalization in large cohorts of patients with AF.21,31 In contrast, this study suggests that the CHA2DS2-VASc score by itself may not be a reliable prognostic marker of in-hospital mortality in critically ill patients with NOAF.
Hospital-level variation and predictors of admission after ED visits for atrial fibrillation: 2006 to 2011
2016, American Journal of Emergency MedicineCitation Excerpt :Second, the CHA2DS2-VASc score was published 2010 as a prediction tool for annual risk for thromboembolic disease and need for oral anticoagulation and incorporated into guidelines for management of AF/AFL in 2014. Although not originally intended as a risk stratification tool to assess need for hospitalization, other studies have demonstrated the association of elevated CHA2DS2-VASc score with increased likelihood of hospitalization and mortality [45,46]. By defining low-risk patients as those with CHA2DS2-VASc score of 0, we are excluding female patients, which may limit the generalizability of this secondary analysis.