Ischaemic cardiovascular mortality in patients with non-valvular atrial fibrillation according to CHADS₂ score.
ABSTRACT The CHADS₂ score predicts the risk of ischaemic stroke in patients with non-valvular atrial fibrillation (NVAF). Most components of the CHADS₂ score are also risk factors of atherosclerosis, and clustering of these risk factors is associated with increased risk of cardiovascular disease, including ischaemic heart disease. The aim of this study was to investigate whether the CHADS₂ score and CHA₂DS₂-VASc score are predictive of fatal ischaemic heart disease as well as fatal ischaemic stroke. Among 5,268 stroke patients admitted between August 1994 and December 2008, 770 stroke patients with NVAF were enroled in this study. The relationship between CHADS₂ score or CHA₂DS₂-VASc score and the fatal ischaemic events was examined using a Cox regression model. During the follow-up period of 1156.0 ± 1205.0 days (median 729.5, interquartile range 179.0-1751.0), 321 patients died (41.7%). The CHADS₂ score or CHA₂DS₂-VASc score was positively correlated with fatal ischaemic heart disease as well as with fatal ischaemic stroke. After adjustment for all potential confounders, the occurrence of fatal ischaemic heart disease was independently associated with CHADS₂ score or CHA₂DS₂-VASc score, and previous history of ischaemic heart disease. The CHADS₂ and CHA₂DS₂-VASc scores provide valuable information for identifying high-risk individuals for fatal ischaemic heart and brain diseases among stroke patients with NVAF.
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ABSTRACT: The epidemiology and prognosis of ‘fainting’ or syncope has puzzled physicians over the years. Is fainting dangerous? This is a question often asked by the patient--and the answer is ‘it depends on a lot of things’. The diverse pathophysiology of syncope and the underlying comorbidites of the patients play an essential role. In epidemiology these factors have major impact on the outcome of the patients. Until recently, even the definition of syncope, differed from one study to another which has made literature reviews difficult. Traditionally the data on epidemiology of syncope has been taken from smaller studies from different clinical settings with wide differences in patient morbidity. Through the extensive Danish registries we examined the characteristics and prognosis of the patients hospitalized due to syncope in a nationwide study. The aims of the present thesis were to investigate: 1) the use, validity and accuracy of the ICD-10 diagnosis of syncope R55.9 in the National Patient Registry for the use of this diagnosis in the epidemiology of syncope, 2) diagnostics used and etiology of a random selection of patients who had a discharge diagnosis of R55.9, 3) the incidence, prevalence and cardiovascular factors associated with the risk of syncope, 4) the prognosis in healthy individuals discharged after syncope, and 5) the prognosis of patients after syncope and evaluation of the CHADS2 score as a tool for short and long-term risk prediction. The first studies of the present thesis demonstrated that the ICD-10 discharge diagnosis could reliably identify a cohort of patients admitted for syncope and that the discharge code carried a high number of unexplained cases despite use of numerous tests. The last studies showed that syncope is a common cause for hospital contact in Denmark and that the risk of syncope is tightly associated with cardiovascular comorbidities and use of pharmacotherapy. Furthermore in patients with no comorbidities (or healthy individuals), syncope is a significant and independent prognostic factor of adverse cardiovascular outcome and death compared to the background population. Lastly evaluation of the CHADS2 score, as a tool for risk stratification, showed that it provided additional prognostic information on short and long-term cardiovascular mortality in syncope patients compared to controls.Danish Medical Journal 08/2013; 60(8):B4702. · 0.61 Impact Factor
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ABSTRACT: Although global left ventricular longitudinal systolic strain (GLS) is a sensitive measure of left ventricular mechanics, its relationship with adverse cardiovascular (CV) events in atrial fibrillation (AF) has not been evaluated. This study sought to examine the ability of GLS in predicting CV events in AF. Observational cohort study. Department of cardiology in a university hospital. 196 persistent AF patients referred for echocardiographic examination. The risk of GLS measured by index beat method for CV events was assessed by Cox proportional hazards analyses. CV events were defined as CV death, non-fatal stroke and hospitalisation for heart failure. There were 19 CV deaths, 12 non-fatal stroke and 28 hospitalisations for heart failure during an average follow-up of 21±10 months. Multivariate analysis showed worsening GLS (HR 1.121; 95% CI 1.023 to 1.228, p=0.014) was independently associated with increased CV events. In direct comparison, GLS outperformed left ventricular ejection fraction (LVEF) and systolic mitral annulus velocity (Sa) in predicting adverse CV events both in univariate and multivariate models (p≤0.043). Besides, the addition of GLS to a Cox model containing chronic heart failure, hypertension, age ≥75 years, diabetes, prior stroke score, estimated glomerular filtration rate, LVEF and Sa provided an additional benefit in the prediction of adverse CV events (p=0.022). GLS was a major parameter and stronger than LVEF and Sa in predicting adverse CV events and could offer an additional prognostic benefit over conventional clinical and echocardiographic systolic parameters in AF.Heart (British Cardiac Society) 09/2013; · 6.02 Impact Factor
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ABSTRACT: Background: CHADS2 and CHA2DS2-VASc scores are validated tools for assessing stroke risk in patients with atrial fibrillation (AF). We investigated whether these scores are associated with 3-month stroke outcomes and evaluated the utility of these scores in stratifying 3-month stroke outcomes in both patients with and without AF. Methods: We analysed 6,612 acute ischaemic stroke patients from the Virtual International Stroke Trials Archive who received either placebo or ineffective active treatments not associated with significant cardiac complications. Outcomes included 3-month mortality, good functional outcomes defined as modified Rankin Scale score ≤1 and serious cardiac adverse events (SCAEs) defined as one of acute coronary syndrome, symptomatic heart failure, cardiopulmonary arrest, life-threatening arrhythmia and cardiac death. The association between the pre-stroke CHADS2 and CHA2DS2-VASc scores and 3-month stroke outcomes was assessed using binary logistic regression. The utility of the two scores in estimating 3-month stroke outcomes was assessed using area under the receiver operator characteristic curves (AUC) and compared using the χ(2) test. Results: In this cohort, 26.5% had AF, 35.3% received IV tissue plasminogen activator (tPA), 17.7% died, 25.1% achieved good functional outcomes and 9.5% had ≥1 SCAE at 3 months. High-risk (≥2) pre-stroke CHADS2 and CHA2DS2-VASc scores are both associated with 3-month mortality (CHADS2: odds ratio, OR, 2.33, 95% confidence interval 1.81-3.00; CHA2DS2-VASc: OR 3.01, 2.00-4.80), good functional outcomes (CHADS2: OR 0.47, 0.39-0.57; CHA2DS2-VASc: OR 0.55, 0.42-0.71) and SCAEs (CHADS2: OR 1.76, 1.28-2.42; CHA2DS2-VASc: OR 2.69, 1.53-4.73) after adjusting for baseline differences in neurological impairment, tPA use and AF. The pre-stroke CHA2DS2-VASc score is better than the CHADS2 score in estimating 3-month stroke outcomes in both patients with and without AF (p ≤ 0.005 in all AUC comparisons). High-risk pre-stroke CHA2DS2-VASc score has high sensitivity for mortality (AF: 0.96, 0.94-0.98; no AF: 0.88, 0.86-0.91) and negative predictive value for SCAE (AF: 0.93, 0.87-0.96; no AF: 0.96, 0.95-0.97) within 3 months. Low risk pre-stroke CHA2DS2-VASc score has high specificity for good functional outcome (AF: 0.99, 0.98-0.994; no AF: 0.94, 0.93-0.95) at 3 months. Conclusions: The pre-stroke CHA2DS2-VASc score appears to be a simple tool for identifying patients at lower risk of poor outcomes and serious cardiac complications within 3 months following ischaemic stroke in patients with and without AF. © 2013 S. Karger AG, Basel.Cerebrovascular Diseases 10/2013; 36(4):273-280. · 3.70 Impact Factor