CHA2DS2-VASc score can guide the screening of atrial fibrillation - cross-sectional study in a geriatric ward
Received 28 February 2019
Accepted for publication 10 April 2019
Published 14 May 2019 Volume 2019:14 Pages 879—887
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Cristina Weinberg
Peer reviewer comments 2
Editor who approved publication: Dr Richard Walker
Zyta Beata Wojszel,1,2 Agnieszka Kasiukiewicz,1,2 Marta Swietek,2,3 Michal Lukasz Swietek,3 Lukasz Magnuszewski2,3
1Department of Geriatrics, Medical University of Bialystok, Bialystok, Poland; 2Department of Geriatrics, Hospital of the Ministry of Interior in Bialystok, Bialystok, Poland; 3Doctoral Studies, Department of Geriatrics, Medical University of Bialystok, Bialystok, Poland
Purpose: Atrial fibrillation (AF) is an increasingly common rhythm disorder and an important risk factor of ischemic stroke, heart failure, hospitalization, and cardiovascular mortality. Its diagnosis, however, is often delayed because of silent character of the arrhythmia. The aim of the study was to identify independent determinants of AF in patients of the geriatric ward, so as to be able to propose a strategy for screening of this arrhythmia.
Methods: Cross-sectional cohort study of patients admitted to the department of geriatrics was conducted. The prevalence of AF and its health correlates (including AF recognized risk factors) was assessed. Relative risks were calculated and multivariable logistic regression analysis model was built. The predictive performance was evaluated using receiver-operating characteristic (ROC) curve analysis.
Results: There were 416 patients hospitalized in the study period and 98 (23.6%) presented with AF. The independent predictors with top 3 strongest association with AF were congestive heart failure (OR 5.43; 95%CI 3.14–9.39; P<0.001), age of 75+years (OR 4.0; 95% CI 1.43–11.2; P=0.008), and previous history of stroke or transient ischemic attack (OR 2.1; 95% CI 1.06–4.13; P=0.03). ROC analysis showed CHA2DS2-VASc scale significance as a screening tool for AF (ROC-AUC 0.75; 0.7–0.8; P<0.001), with the value of 4 or more as the best cut-off point.
Conclusions: Based on CHA2DS2-VASc score the intensity of surveillance for AF at a primary prevention population level could be probably guided, but it requires further research.
Keywords: atrial fibrillation screening, older people, risk factors and determinants, CHA2DS2-VASc score
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