Journal
ESC HEART FAILURE
Volume 8, Issue 2, Pages 1369-1377Publisher
WILEY PERIODICALS, INC
DOI: 10.1002/ehf2.13217
Keywords
Heart failure; Atrial fibrillation; Risk prediction
Categories
Funding
- National Natural Science Foundation of China [81770392, 81770394, 81700344, 81800344, 81800345]
- Science and Technology Program Foundation of Guangzhou [201707010124]
- Guangdong Natural Science Foundation [2017A030310311, 2017A030313795]
- Young Teachers' Basic Scientific Research Business Expenses Project [20ykpy72]
- Medical Research Foundation of Guangdong Province [A2017030, A2018107, A2018082]
- China Postdoctoral Science Foundation [2019M663312, 2019TQ0380, 2019M660229]
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This study examined the utility of CHADS2, R2CHADS2, and CHA2DS2-VASc scores in predicting incident AF in HFpEF patients, revealing their ability to predict AF risk with moderate accuracy.
Aims Coexisting of atrial fibrillation (AF) in patients with heart failure with preserved ejection fraction (HFpEF) could increase the risk of mortality. In this study, we aimed to assess the values of the CHADS2, R2CHADS2, and CHA2DS2-VASc scores for AF prediction in HFpEF patients. Methods and results We performed a retrospective analysis on symptomatic HFpEF patients in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial. Associations of the CHADS2, R2CHADS2, and CHA2DS2-VASc scores with the risk of incident AF in HFpEF patients without baseline AF (n = 2202) were assessed using the multivariable competing risk regression models. The discriminatory performances of these scores were calculated using the C-index. During a median follow-up of 3.3 years, the average incidence of AF was 1.80 per 100 patient-years in HFpEF patients. When score was analysed as a continuous variable, per 1-point increase in the CHADS2 (hazard ratio [HR] = 1.42, 95% confidence interval [CI]: 1.20-1.68, C-index: 0.71), R2CHADS2 (HR = 1.25, 95% CI: 1.10-1.42, C-index: 0.69), or CHA2DS2-VASc (HR = 1.30, 95% CI: 1.16-1.46, C-index: 0.70) scores was associated with an increased risk of incident AF. When score was analysed as a categorical variable, patients with CHADS2 >= 3 (HR = 2.62, 95% CI: 1.70-4.04), R2CHADS2 >= 3 (HR = 2.55, 95% CI: 1.56-4.17), or CHA2DS2-VASc >= 4 (HR = 2.54, 95% CI: 1.59-4.07) had a higher risk of incident AF compared with the corresponding controls. Conclusions Our data first suggest that the CHADS2, R2CHADS2, and CHA2DS2-VASc scores could predict the risk of incident AF in HFpEF patients with modest predictive abilities.
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