Value of the CHA(2)DS(2)‐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 CHA(2)DS(2)‐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 CHA(2)DS(2)‐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 CHA(2)DS(2)‐VASc score was 5.0 (range 4.0–6.0). The CHA(2)DS(2)‐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 CHA(2)DS(2)‐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 CHA(2)DS(2)‐VASc scores were independently predictive of survival and of the combined end point of death and cardiovascular hospitalization by Cox regression analysis. Analysing the CHA(2)DS(2)‐VASc score as a continuous parameter by cox regression analysis demonstrated a significant increase with each point increase in the CHA(2)DS(2)‐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 CHA(2)DS(2)‐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 CHA(2)DS(2)‐VASc score has a significant impact on outcome in HF patients.