CHA ₂DS ₂-VASc score stratifies mortality risk in heart failure patients aged 75 years and older with and without atrial fibrillation

Abstract

Background

During the last decade, the CHA ₂DS ₂-VASc score has been associated with adverse clinical outcomes in several cardiovascular (CV) and non-cardiovascular diseases beyond atrial fibrillation (AF). Whether the CHA ₂DS ₂-VASc score stratifies mortality risk in elderly patients with AF and without AF is not well established.

Methods

All consecutive patients aged ≥ 75 yrs hospitalized due to heart failure (HF), between January 2020 and November 2020, were retrospectively enrolled. All patients underwent physical examination, blood tests, electrocardiography and conventional transthoracic echocardiography. Primary endpoint was all-cause mortality, while secondary endpoint was the composite of all-cause mortality + rehospitalizations for all causes over mid-term follow-up.

Results

The study included 261 HF patients (86.3 ± 6.4 years, 60.5% females). 85 AF and 176 non-AF patients were separately analyzed. Compared to non-AF patients, those with AF had significantly higher CHA ₂DS ₂-VASc score (5.6 ± 1.4 vs 5.1 ± 1.4, p = 0.007) and lower ejection fraction (47.4 ± 16.5 vs 56.7 ± 15.1%, p < 0.001). Mean follow-up was 1.7 ± 0.5 yrs. During follow-up, 96 patients died (58.3% due to CV causes) and 79 were rehospitalized (58.2% due to CV causes). CHA ₂DS ₂-VASc score was independently associated with all-cause mortality in whole study population (HR 1.61, 95% CI 1.36–1.92) and in both AF (HR 1.41, 95% CI 1.09–1.82) and non-AF patients (HR 1.84, 95% CI 1.40–2.40). CHA ₂DS ₂-VASc score also predicted the secondary endpoint in the same study groups. CHA ₂DS ₂-VASc score ≥ 5 was the best cut-off value for predicting both outcomes.

Conclusion

At mid-term follow-up, a CHA ₂DS ₂-VASc score ≥ 5 predicts increased risk of all-cause mortality and re-hospitalizations for all causes in elderly HF patients, regardless of AF.