CHA(2)DS(2)-VASc score and left atrial volume dilatation synergistically predict incident atrial fibrillation in hypertension: an observational study from the Campania Salute Network registry

Arterial hypertension is a leading risk factor for developing atrial fibrillation. CHA(2)DS(2)-VASc score can help to decide if patients with atrial fibrillation need anticoagulation. Whether CHA(2)DS(2)-VASc may predicts incident atrial fibrillation and how it interacts with left atrial dilatation is unknown. We tested this hypothesis in a large registry of treated hypertensive patients. From 12154 hypertensive patients we excluded those with prevalent atrial fibrillation (n 51), without follow-up (n 3496), or carotid ultrasound (n 1891), and low ejection fraction (i.e. <50%, n 119). A CHA(2)DS(2)-VASc score ≥3 was compared with CHA(2)DS(2)-VASc score ≤2. Incident symptomatic or occasionally detected atrial fibrillation was the end-point of the present analysis. At baseline, 956 (15%) patients exhibited high CHA(2)DS(2)-VASc; they were older, most likely to be women, obese and diabetic, with lower glomerular filtration rate, and higher prevalence of left ventricular hypertrophy, left-atrial dilatation and carotid plaque (all p < 0.005). Prevalent Stroke/TIA was found only in the subgroup with high CHA(2)DS(2)-VASc. During follow-up (median = 54 months) atrial fibrillation was identified in 121 patients, 2.57-fold more often in patients with high CHA(2)DS(2)-VASc (95% Cl 1.71–4.86 p < 0.0001). In multivariable Cox analysis, CHA(2)DS(2)-VASc increased incidence of atrial fibrillation by 3-fold, independently of significant effect of left-atrial dilatation (both p < 0.0001) and other markers of organ damage. Incident AF is more than doubled in hypertensive patients with CHA(2)DS(2)-VASc ≥3. Coexisting CHA(2)DS(2)-VASc score >3 and LA dilatation identify high risk subjects potentially needing more aggressive management to prevent AF and associated cerebrovascular ischemic events.