Ischaemic cardiovascular mortality in patients with non-valvular atrial fibrillation according to CHADS(2) score

ArticleinThrombosis and Haemostasis 105(4):712-20 · February 2011with9 Reads
Impact Factor: 4.98 · DOI: 10.1160/TH10-11-0692 · Source: PubMed
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.

    • "In Paper V we tested the hypothesis that the CHADS2 score is a useful tool for risk stratification of cardiovascular and all-cause mortality. The CHADS2 score predicted short and long-term mortality in this population which was expected as the CHADS2 score probably predicts mortality in many subsets of populations4344454647. The evaluation of the score revealed that the CHADS2 score may provide additional prognostic information on risk stratification in syncope patients when compared to a control population stratified by the same CHADS2 scores. "
    [Show abstract] [Hide abstract] 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.
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