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CHA2DS2-VASc and ATRIA Scores and Clinical Outcomes in Patients with Heart Failure with Preserved Ejection Fraction

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Abstract

Background

Heart failure (HF) patients have high risks of thromboembolic events regardless of the category of left ventricular ejection fraction. We sought to assess whether the CHA2DS2-VASc (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke, vascular disease, age 65–74 years, and female sex) and ATRIA (anticoagulation and risk factors in atrial fibrillation) scores could predict clinical outcomes in HF patients with preserved ejection fraction (HFpEF).

Methods

We performed a retrospective analysis in a multicenter, America-based population of 1766 HFpEF patients who were stratified according to their baseline CHA2DS2-VASc or ATRIA scores. The CHA2DS2-VASc and ATRIA scores were analyzed as a continuous or categorical variable. The outcomes were stroke, all-cause death, cardiovascular death, any hospitalization, and HF hospitalization.

Results

When score was considered as a continuous variable, each point increase in CHA2DS2-VASc was associated with increased risks of stroke (hazard ratio (HR) 1.22, 95% confidence interval (CI) = 1.06–1.41, C-index = 0.62), HF hospitalization (HR 1.08, 95% CI = 1.01–1.17, C-index = 0.59), and any hospitalization (HR 1.06, 95% CI = 1.01–1.11, C-index = 0.57) whereas each point increase in ATRIA was associated with increased risks of stroke (HR 1.11, 95% CI = 1.01–1.21, C-index = 0.62), all-cause death (HR 1.09, 95% CI = 1.05–1.14, C-index = 0.61), cardiovascular death (HR 1.08, 95% CI = 1.02–1.14, C-index = 0.59), HF hospitalization (HR 1.07, 95% CI = 1.03–1.12, C-index = 0.58), and any hospitalization (HR 1.04, 95% CI = 1.01–1.06, C-index = 0.57). When score was regarded as a categorical variable, compared with controls, CHA2DS2-VASc ≥ 4 was associated with increased risks of stroke and hospitalization whereas ATRIA ≥ 8 was associated with increased risks of stroke, death, and hospitalization.

Conclusions

The CHA2DS2-VASc and ATRIA scores are associated with risks of adverse outcomes in HFpEF patients. However, the predictive abilities of CHA2DS2-VASc and ATRIA are modest, and their clinical utility in HFpEF remains to be determined.

Clinical trial registration

https://clinicaltrials.gov. Identifier: NCT00094302

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Acknowledgments

We gratefully acknowledge the patients, investigators, research coordinators, and committee members of the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial.

Funding

This study was funded by the Natural Science Foundation of China (No. 81770392, No. 81770394, No. 81700344, No. 81800344, and No. 81800345), Science and Technology Program Foundation of Guangdong (No. 2017A020215156), and Medical Research Foundation of Guangdong Province (No. A2018107, No. A2018082).

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Authors and Affiliations

  1. Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong, People’s Republic of China

    Wengen Zhu, Yuzhong Wu, Yuanyuan Zhou, Weihao Liang, Ruicong Xue, Zexuan Wu, Yugang Dong & Chen Liu

  2. NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, 510080, People’s Republic of China

    Yugang Dong & Chen Liu

  3. National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, People’s Republic of China

    Yugang Dong & Chen Liu

Authors
  1. Wengen Zhu
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  2. Yuzhong Wu
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  3. Yuanyuan Zhou
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  4. Weihao Liang
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  7. Yugang Dong
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  8. Chen Liu
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Contributions

Under the directions of Yugang Dong and Chen Liu, Yuzhong Wu and Wengen Zhu performed the study design, data extraction, and statistical analysis. Wengen Zhu and Yuzhong Wu wrote the original draft while Chen Liu revised the draft. All other authors helped check the data to ensure accuracy and edit the manuscript prior to submission to ensure the standard English grammar.

Corresponding authors

Correspondence to Yugang Dong or Chen Liu.

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The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Wengen Zhu and Yuzhong Wu are co-authors.

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Zhu, W., Wu, Y., Zhou, Y. et al. CHA2DS2-VASc and ATRIA Scores and Clinical Outcomes in Patients with Heart Failure with Preserved Ejection Fraction. Cardiovasc Drugs Ther 34, 763–772 (2020). https://doi.org/10.1007/s10557-020-07011-y

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