Changes in the CHA(2)DS(2)-VAS(C) score as a predictor of incident atrial fibrillation in older Chinese individuals: the AF-CATCH study

AIMS: Incidence of atrial fibrillation is highly associated with age and cardiovascular co-morbidities. Given this relationship, we hypothesized that the dynamic changes resulting in an increase in the CHA(2)DS(2)-VAS(C) score over time would improve the efficiency of predicting incident atrial fibrillation on repeated screening after a negative test. METHODS AND RESULTS: We investigated in an analysis of the AF-CATCH trial [quarterly vs. annual electrocardiogram (ECG) screening for atrial fibrillation in older Chinese individuals] data, the association between the changes in the CHA(2)DS(2)-VAS(C) score from baseline to end-of-study visit and the risk of incident atrial fibrillation. Participants without a history of atrial fibrillation and with a sinus rhythm at baseline were randomized to the annual (usual) or quarterly 30 s (intensive) single-lead ECG screening groups. During a median follow-up of 2.1 years in 6806 participants, the incidence rate of atrial fibrillation increased from 4.2 per 1000 person-years in participants with a change in the CHA(2)DS(2)-VAS(C) score of 0 to 6.4 and 25.8 per 1000 person-years in participants with a change in the CHA(2)DS(2)-VAS(C) score of 1 and ≥2, respectively. A change in the CHA(2)DS(2)-VAS(C) score of ≥2 was associated with a significantly elevated risk of incident atrial fibrillation. CONCLUSIONS: Patients with substantial changes in the CHA(2)DS(2)-VAS(C) score were more likely to develop incident atrial fibrillation, and regular re-assessments of cardiovascular risk factors in the elderly are probably worthwhile to improve the detection of atrial fibrillation. REGISTRATION: URL: http://www.clinicaltrials.gov; Unique identifier: NCT02990741.