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CHADS2 score has a better predictive value than CHA2DS2-VASc score in elderly patients with atrial fibrillation

Authors Xing Y, Ma Q, Ma X, Wang C, Zhang D, Sun Y

Received 29 January 2016

Accepted for publication 31 March 2016

Published 14 July 2016 Volume 2016:11 Pages 941—946


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Zhi-Ying Wu

Yunli Xing, Qing Ma, Xiaoying Ma, Cuiying Wang, Dai Zhang, Ying Sun

Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China

Aim: The study aims to compare the ability of CHA2DS2-VASc (defined as congestive heart failure, hypertension, age ≥75 years [two scores], type 2 diabetes mellitus, previous stroke, transient ischemic attack, or thromboembolism [TE] [doubled], vascular disease, age 65–74 years, and sex category) and CHADS2 (defined as congestive heart failure, hypertension, age ≥75 years, type 2 diabetes mellitus, previous stroke [doubled]) scores to predict the risk of ischemic stroke (IS) or TE among patients with nonvalvular atrial fibrillation (NVAF).
Methods: A total of 413 patients with NVAF aged ≥65 years, and not on oral anticoagulants for the previous 6 months, were enrolled in the study. The predictive value of the CHA2DS2-VASc and CHADS2 scores for IS/TE events was evaluated by the Kaplan–Meier method.
Results: During a follow-up period of 1.99±1.29 years, 104 (25.2%) patients died and 59 (14.3%) patients developed IS/TE. The CHADS2 score performed better than the CHA2DS2-VASc score in predicting IS/TE as assessed by c-indexes (0.647 vs 0.615, respectively; P<0.05). Non-CHADS2 risk factors, such as vascular disease and female sex, were not found to be predictive of IS/TE (hazard ratio 1.518, 95% CI: 0.832–2.771; hazard ratio 1.067, 95% CI: 0.599–1.899, respectively). No differences in event rates were found in patients with the CHADS2 scores of 1 and 2 (7.1% vs 7.8%). It was observed that patients with a CHADS2 score of ≥3 were most in need of anticoagulation therapy.
Conclusion: In patients with NVAF aged ≥65 years, the CHADS2 score was found to be significantly better in predicting IS/TE events when compared to the CHA2DS2-VASc score. Patients with a CHADS2 score of ≥3 were associated with high risk of IS/TE events.

Keywords: NVAF, vascular disease, sex, elderly

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