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Effect of anticoagulation on mortality by CHADSVASC score in patients with atrial fibrillation: comparison to patients without atrial fibrillation

Session Atrial fibrillation - Anticoagulation

Speaker Serge Harb

Event : ESC Congress 2018

  • Topic : arrhythmias and device therapy
  • Sub-topic : Arrhythmias, General – Epidemiology, Prognosis, Outcome
  • Session type : Moderated Posters

Authors : S Harb (Cleveland,US), AAH Hussein (Cleveland,US), WIS Saliba (Cleveland,US), YU Wu (Cleveland,US), BX Xu (Cleveland,US), LC Cho (Cleveland,US), OMW Wazni (Cleveland,US), WAJ Jaber (Cleveland,US)

Authors:
S. Harb1 , A.A.H. Hussein1 , W.I.S. Saliba1 , Y.U. Wu1 , B.X. Xu1 , L.C. Cho1 , O.M.W. Wazni1 , W.A.J. Jaber1 , 1Cleveland Clinic Foundation - Cleveland - United States of America ,

Citation:
European Heart Journal ( 2018 ) 39 ( Supplement ), 1075

Background: The CHADSVASC score is a well-established tool to estimate the embolic risk in patients with atrial fibrillation (afib) and guide decision for anticoagulation (AC). It is well known that AC is beneficial for stroke prevention when CHADSVASC scores ≥2.

Purpose: The aim of this study was to assess the association of CHADSVASC score with mortality and determine how it is impacted by AC use in patients with afib.

Methods: We computed the CHASDVASC score in all patients referred to our stress testing laboratory between 1990 and 2014. Patients were divided into 3 groups: no afib, afib on AC, and afib not on AC; then categorized into 5 CHADSVASC scores: 0–1; 2; 3; 4; and 5–9. Mortality was determined based on the social security and institutional death indexes and compared among the 3 groups of patients by CHASDSVASC score.

Results: A total of 165,184 patients were included (mean age 55.8±12.9, 58% male). Mean CHADSVASC score was 2.2±1.3 and 22,152 patients died during a mean follow up of 8.7 years. Mortality among the 3 group of patients and by CHADVASC score is presented in table 1. Figure 1, compares the death rates among the 3 groups. Higher CHADSVASC was associated with higher mortality across the 3 groups and afib conferred an incremental risk. In patients with scores of 0–1 and 2, the highest mortality was observed in those with afib on AC. For scores of 3 and 4, mortality was similar between afib patients on or off AC. When CHADSVASC score was 5 or higher, AC conferred a protective effect and blunted the added risk of afib i.e. there was no significant difference in mortality between patients with no afib and those with afib on AC (44.8% vs. 54.3%, p=0.553).

Conclusion: CHADSVASC score and afib are independent risk factors of mortality. At low CHADSVASC scores ≤2, AC was associated with higher mortality. The protective effect of AC on mortality in patients with afib was only observed for scores ≥5.

Mortality by group and CHADSVASC score
CHADSVASCNo afib (n=152,734)Afib on AC (n=6,234)Afib off AC (n=5,773)p value
0–1 (n=80,048)4.5% (3,442/77,167)10.3% (106/1,027)6.9% (116/1,683)<0.001
2 (n=40,730)12.3% (4,604/37,552)21.9% (347/1,582)16.7% (251/1,507)<0.001
3 (n=24,833)22.2%(4,866/21,895)33.6% (538/1,600)33.5% (426/1,271)<0.001
4 (n=12,222)31.5% (3,233/10,263)39.6% (450/1,136)42.7% (324/758)<0.001
5–9 (n=7351)44.8% (2,622/5,857)45.9% (408/889)54.3% (301/554)<0.001
afib = atrial fibrillation, AC = anticoagulation.
Mortality by group and CHADSVASC score

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