Does the CHA₂DS₂-VASc score reliably predict atrial arrhythmias? Analysis of a nationwide database of remote monitoring data transmitted daily from cardiac implantable electronic devices

Background: CHA₂DS₂-VASc is a validated score for predicting stroke in patients with atrial fibrillation (AF).

Objective: The purpose of this study was to assess whether the CHA₂DS₂-VASc score can predict new-onset AF in a cohort of patients with a cardiac implantable electronic device (CIED) followed with remote monitoring.

Methods: Using the database of the Home Monitoring Expert Alliance project, we selected 2410 patients with no documented AF who had received a CIED with diagnostics on atrial high rate episodes (AHREs). The primary endpoint was time to first day with cumulative AHRE burden ≥15 minutes, 5 hours, 24 hours, and ≥7 consecutive days.

Results: During a median duration of 24.1(11.5-42.9) months, the incidence of AHRE increased with increasing CHA₂DS₂-VASc. At 6 years, occurrence of ≥15-minute AHRE was 80.2% (CHA₂DS₂-VASc ≤1) vs 93.7% (CHA₂DS₂-VASc ≥5), whereas ≥5-hour AHRE incidence was 68.4% (CHA₂DS₂-VASc ≤1) vs 92.5% (CHA₂DS₂-VASc ≥5). Occurrence of ≥24-hour and ≥7-day AHREs also increased with increasing CHA₂DS₂-VASc: 9.1% and 3.9% (CHA₂DS₂-VASc ≤1) vs 40.4% and 28.7% (CHA₂DS₂-VASc ≥5), respectively. Adjusted hazard ratio for unitary CHA₂DS₂-VASc increase ranged from 1.09 (confidence interval 1.04-1.14; P <.001) with AHRE burden ≥15 minutes to 1.26 (confidence interval 1.11-1.42; P <.001) with AHRE burden ≥7 days. At receiver operating curve analysis, CHA₂DS₂-VASc ≥2 was estimated to predict persistent forms of AHREs with 95.8% sensitivity but 11.7% specificity at 3 years. CHA₂DS₂-VASc ≥5 had 77.0% specificity but 34.6% sensitivity.

Conclusion: In a CIED population with no previous diagnosis of clinical AF, AHRE incidence increased with increasing CHA₂DS₂-VASc score. The association was stronger with longer AHREs, but the accuracy of CHA₂DS₂-VASc as AHRE predictor was moderate.