title: CHADS2 and CHA2DS2-VASc scores to predict morbidity and mortality in heart failure patients candidates to cardiac resynchronization therapy.
abstract: OBJECTIVE
  CHADS2 and CHA2DS2-VASc scores are pivotal in assessing the risk of stroke in atrial fibrillation patients, and were recently proved to predict hospitalizations and mortality in specific clinical settings. Aim of this study was to evaluate whether these scores could predict clinical outcomes [first hospitalization for heart failure (HF) and a combined event of HF hospitalization and death for any cause] in patients candidates to cardiac resynchronization therapy and implantable defibrillator (CRT-D).
  
  
  RESULTS
  In a retrospective multicentre Italian study, we enrolled 559 consecutive HF patients candidates to CRT-D, and we grouped them in three pre-specified risk classes: low (CHADS2/CHA2DS2-VASc 1-2), moderate (CHADS2/CHA2DS2-VASc 3-4), and high (CHADS2 5-6/CHA2DS2-VASc 5-8). All patients underwent regular follow-up at implanting centres every 6 months; data collection was extended till the 72th month of follow-up. At a median FU of 30 months, 143 patients (25.4%) were hospitalized for HF and 110 (19.5%) died. Event-free survival analysis showed a significant difference according to baseline CHADS2 and CHA2DS2-VASc scores (Log-Rank for HF P < 0.001 for CHADS2 and CHA2DS2-VASc; Log-Rank for combined end-point P = 0.001 for CHADS2, P < 0.001 for CHA2DS2-VASc). At multivariate analysis, independent predictors of endpoints were: previous atrial fibrillation (AF) or AF at implant, NYHA class, QRS duration and the CHA2DS2-VASc score (for HF hospitalization P = 0.013; for the combined event, P = 0.007), while the CHADS2 score was not independently associated with either the end-points.
  
  
  CONCLUSIONS
  In CRT-D patients, pre-implant CHA2DS2-VASc score is an independent predictor of major clinical events at 30-month follow-up.
authors.affiliation: Dipartimento Cuore e Vasi, Università degli Studi di Firenze, Viale Morgagni 85, Firenze 50134, Italia.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Paoletti Perini
authors.forename: Simone
authors.initials: S
authors.lastname: Bartolini
authors.forename: Paolo
authors.initials: P
authors.lastname: Pieragnoli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ricciardi
authors.forename: Laura
authors.initials: L
authors.lastname: Perrotta
authors.forename: Alessandro
authors.initials: A
authors.lastname: Valleggi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Vergaro
authors.forename: Federica
authors.initials: F
authors.lastname: Michelotti
authors.forename: Giulio
authors.initials: G
authors.lastname: Boggian
authors.forename: Biagio
authors.initials: B
authors.lastname: Sassone
authors.forename: Giosuè
authors.initials: G
authors.lastname: Mascioli
authors.forename: Michele
authors.initials: M
authors.lastname: Emdin
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
mesh_terms: D017677:Age Distribution; D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000706:statistics & numerical data*; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007558:Italy; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000401:mortality* / Q000517:prevention & control*
keywords: CHA2DS2-VASc; CHADS2; Cardiac resynchronization therapy; Heart failure; Hospitalization; Mortality