Usefulness of the CHA2DS2-VASc Score to Predict the Risk of Sudden Cardiac Death and Ventricular Arrhythmias in Patients With Atrial Fibrillation

Ling Kuo; Tze-Fan Chao; Chia-Jen Liu; Su-Jung Chen; Ta-Chuan Tuan; Yenn-Jiang Lin; Shih-Lin Chang; Li-Wei Lo; Yu-Feng Hu; Fa-Po Chung; Jo-Nan Liao; Tzeng-Ji Chen; Gregory Y H Lip; Shih-Ann Chen

doi:10.1016/j.amjcard.2018.08.056

Usefulness of the CHA₂DS₂-VASc Score to Predict the Risk of Sudden Cardiac Death and Ventricular Arrhythmias in Patients With Atrial Fibrillation

Am J Cardiol. 2018 Dec 15;122(12):2049-2054. doi: 10.1016/j.amjcard.2018.08.056. Epub 2018 Sep 13.

Authors

Affiliations

¹ Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.
² Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan. Electronic address: [email protected].
³ Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Public Health and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
⁴ Institute of Public Health and School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
⁵ Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
⁶ University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom. Electronic address: [email protected].

PMID: 30342698
DOI: 10.1016/j.amjcard.2018.08.056

Abstract

Sudden cardiac death (SCD), the most devastating manifestation of ventricular arrhythmias (VAs), is the leading cause of mortality in patients with atrial fibrillation (AF). We hypothesized that the CHA₂DS₂-VASc score, consisting of age and several clinical risk factors, could be used to estimate the individual risk of SCD/VAs for AF patients. From year 2000 to 2011, 288,181 newly-diagnosed AF patients without antecedent SCD/VAs were identified from "Taiwan National Health Insurance Research Database." During the follow-up of 1,065,751 person-years, 11,166 patients experienced SCD/VAs with an annual risk of 1.05% which increased from 0.34% for patients with a CHA₂DS₂-VASc score of 0% to 2.63% for those with a score of 9. The CHA₂DS₂-VASc score was a significant predictor of SCD/VAs with an adjusted hazard ratio of 1.21 (95% confidence interval 1.20 to 1.22) per 1 point increment of the score. As the CHA₂DS₂-VASc score increased from 1 to 9, the hazard ratio of SCD/VAs continuously increased from 1.28 to 4.17 compared with patients with a CHA₂DS₂-VASc score of 0. In conclusion, CHA₂DS₂-VASc score was a convenient scoring system which could be used to predict the risk of SCD/VAs in AF patients in addition to its ability for stroke risk stratification.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Atrial Fibrillation / complications*
Atrial Fibrillation / diagnosis
Atrial Fibrillation / mortality
Death, Sudden, Cardiac / epidemiology*
Death, Sudden, Cardiac / etiology
Female
Humans
Incidence
Male
Middle Aged
Prognosis
Registries*
Retrospective Studies
Risk Assessment / methods*
Risk Factors
Survival Rate / trends
Tachycardia, Ventricular / complications*
Tachycardia, Ventricular / diagnosis
Tachycardia, Ventricular / mortality
Taiwan / epidemiology