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Prognostic value of CHADSVASC score on mortality in patients referred for stress testing with and without atrial fibrillation

Session Poster Session 1

Speaker Serge Harb

Event : ESC Congress 2018

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

Authors : S Harb (Cleveland,US), AAH Hussein (Cleveland,US), WIS Saliba (Cleveland,US), BX Xu (Cleveland,US), YU Wu (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 , B.X. Xu1 , Y.U. Wu1 , 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 ), 206-207

Background: The CHADSVASC score is the preferred risk model to estimate the embolic risk in patients with atrial fibrillation (afib). Recent studies have reported that it may also be useful as a prognostic marker in patients without afib.

Purpose: We sought to assess whether the CHADSVASC score is an independent predictor of mortality in patients referred for stress testing irrespective of the presence of afib, exercise capacity (measured by metabolic equivalents i.e. METs) and medication use including anticoagulants (AC).

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. Uni and multivariate analysis were used to determine the association of CHADSVASC score with mortality. An interaction plot of the risk of death by CHADSVASC score, presence of afib and use of AC was then computed.

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. On uni-and multivariate analysis, CHADSVASC score was associated with mortality (HR = 1.23; 95% CI = 1.21–1.25; p<0.01) even after adjusting for exercise capacity (METs), presence of afib and AC use, and other comorbidities and cardiac medications (Table 1). The interaction plot in figure 1 shows higher mortality by CHADSAVASC score, presence of afib and lack of AC use.

Conclusion: The CHADSVASC score is an overall prognostic tool independently associated with mortality, even after adjusting for exercise capacity, presence of afib and AC use. The presence of afib, particularly off AC, is an additive risk factor.

Multivariate associations with mortality
HR with 95% CIP value
CHADSVASC1.23 (1.21–1.25)<0.001
Afib1.18 (1.1–1.27)<0.001
ESRD2.33 (2.1–2.59)<0.001
Smoker1.65 (1.58–1.73)<0.001
METs0.73 (0.72–0.74)<0.001
AC1.5 (1.4–1.6)<0.001
Statin0.85 (0.81–0.9)<0.001
Afib: atrial fibrillation, ESRD: end stage renal disease, METs: metabolic equivalent, AC: anticoagulation.
Interaction plot

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