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.