Value of the CHA₂DS₂-VASc score for predicting outcome in patients with heart failure

Aims: Comorbidities are highly prevalent in patients with heart failure (HF) and affect clinical outcome. The CHA₂DS₂-VASc score is a validated score to estimate assessment of thromboembolic risk in patients with atrial fibrillation. Methods and results: We evaluated the predictive value of this score on clinical outcome in patients with HF. All patients with a diagnosis of chronic HF at a health maintenance organization were evaluated for the CHA₂DS₂-VASc score. Patients were followed for cardiac related hospitalizations and death. The cohort included 7106 HF patients. Mean follow-up was 744 days; the median CHA₂DS₂-VASc score was 5.0 (range 4.0–6.0). The CHA₂DS₂-VASc score was a significant predictor of survival and predictive of the combined end point of death and cardiovascular hospitalization. Survival rates were reduced with increasing quintiles of the CHA₂DS₂-VASc score: 93.6 ± 0.7% vs. 83.0 ± 1.1% vs. 75.7 ± 1.0% vs. 73.0 ± 1.2% vs. 63.3 ± 1.2%, respectively P < 0.001. After adjustment for other significant predictors, increasing CHA₂DS₂-VASc scores were independently predictive of survival and of the combined end point of death and cardiovascular hospitalization by Cox regression analysis. Analysing the CHA₂DS₂-VASc score as a continuous parameter by cox regression analysis demonstrated a significant increase with each point increase in the CHA₂DS₂-VASc score (hazard ratio 1.21, 95% confidence interval 1.17–1.26, P < 0.0001). Cox regression analysis using restricted cubic splines demonstrated an independent continuous increase in mortality with increasing CHA₂DS₂-VASc score (P < 0.0001 adjusted linear model). The predictive value was present in HF with reduced as well as preserved ejection fraction. Conclusions: The CHA₂DS₂-VASc score has a significant impact on outcome in HF patients.