Mortality prediction using CHADS(2)/CHA(2)DS(2)-VASc/R(2)CHADS(2) scores in systolic heart failure patients with or without atrial fibrillation

The CHADS(2), CHA(2)DS(2)-VASc, and R(2)CHADS(2) scores are well-known predictors of stroke caused by atrial fibrillation (AF), but no studies have evaluated their use for stratifying all-cause mortality risk in patients discharged for systolic heart failure (SHF) with or without AF. This study analyzed data in the Taiwan Society of Cardiology—heart failure with reduced ejection fraction (TSOC-HFrEF) registry. These data were obtained by a prospective, multicenter, observational survey of patients treated at 21 medical centers in Taiwan after hospitalization for acute, pre-existing or new onset SHF from May, 2013 to October, 2014. During 1 year follow-up, 198 patients were lost follow-up, and final 1311 (86.8%) patients were included for further analysis. During the follow-up period, 250 (19%) patients died. Multivariate analysis revealed that body mass index, thyroid disorder, valvular surgery history, chronic kidney disease (CKD), and scores for CHADS(2), CHA(2)DS(2-)VASc, and R(2)CHADS(2) were significant independent predictors of mortality in the overall population of SHF patients (all P < .05) The c-indexes showed that CHADS(2), CHA(2)DS(2)-VASc, and R(2)CHADS(2) scores were significantly associated with mortality in SHF patients with or without AF (all P < 005). However, R(2)CHADS(2) had significantly higher accuracy in predicting mortality in all SHF patients compared with CHADS(2) and CHA(2)DS(2)-VASc (DeLong test, P < .0001), especially in SHF without AF (DeLong test, P = .0003). Scores for CHADS(2), CHA(2)DS(2)-VASc, and R(2)CHADS(2) can be used to predict 1-year all-cause mortality in SHF patients with or without AF. For predicting all-cause mortality in SHF patients, R(2)CHADS(2) is more accurate than CHADS(2) and CHA(2)DS(2)-VASc.