CHADS-VASc Score predicts stroke and death in congestive heart failure patients

The CHA₂DS₂-VASc score (congestive heart failure, hypertension, age ≥75 years [doubled], diabetes, stroke/transient ischemic attack/thromboembolism [doubled], vascular disease [prior myocardial infarction, peripheral artery disease, or aortic plaque], age 65-75 years, sex category [female]) is used clinically for stroke risk stratification in atrial fibrillation (AF). However, whether it can predict these outcomes in patients with heart failure remained unknown.

Melgaard et al, examined the nationwide prospective cohort study using Danish registries, including 42,987 patients (21.9% with concomitant AF) not receiving anticoagulation who were diagnosed as having incident HF during 2000-2012.

In patients without AF, the risks of ischemic stroke, thromboembolism, and death were 3.1% (n = 977), 9.9% (n = 3187), and 21.8% (n = 6956), respectively.  The risks were greater with increasing CHA₂DS₂-VASc scores. Interestingly, the absolute risk of thromboembolic complications was higher among patients without AF compared with patients with concomitant AF at high CHA₂DS₂-VASc scores. However, predictive accuracy was modest, and the clinical utility of the CHA₂DS₂-VASc score in patients with HF remains to be determined.

Treatment of Abdominal Aortic Aneurysm

What is a better treatment option for patients with abdominal aortic aneurysms (AA)? Currently, there are two main options; endovascular repair (below left) or open surgical repair (below right).

Chang and his colleagues analyzed the longitudinally linked California Office of Statewide Health Planning and Development inpatient database from 2001 to 2009 with a median follow-up of 3.3 years. They studied 23,670 patients, with 52% receiving endovascular repair. Endovascular repair was associated with improved 30-day outcomes (all-cause mortality, readmission, surgical site infection, pneumonia, and sepsis), as well as significantly improved survival until 3 years postoperatively. After 3 years, mortality was higher for patients who underwent an endovascular repair. No significant difference in long-term mortality was observed for the entire cohort on adjusted analysis (hazard ratio, 0.99; 95% CI, 0.94-1.04; P = .64). Endovascular repair was found to be associated with a significantly higher rate of re-interventions and AAA late ruptures.

Some Stuff from ESC

 

Warfarin Discontinuation Increases Stroke Risk

Non-steroidal Mineralcorticoid Receptor Antagonist Could Cut Mortality

One study says:
- Stimulation of either the right or left vagus nerve appeared to improve cardiac function in patients with heart failure
And other one says:
- Stimulating the vagus nerve didn't improve cardiac function in heart failure patients
Go figure!