title: CHA2DS2-VASc score is directly associated with the risk of pulmonary embolism in patients with atrial fibrillation.
abstract: BACKGROUND
  The risk stratification score, which includes Congestive heart failure, Hypertension, Age ≥ 75 [doubled], Diabetes, Stroke [doubled]- Vascular disease, Age 65-74, and Sex category [female] (CHA2DS2-VASc), is used to predict stroke in atrial fibrillation. However, whether high CHA2DS2-VASc score carries a higher risk of pulmonary embolism remains unknown. We aimed to investigate the association between the severity of CHA2DS2-VASc score and the incidence of pulmonary embolism.
  
  
  METHODS
  A total of 73,541 adults with atrial fibrillation diagnosed before January 1, 2012, and no history of pulmonary embolism, were retrospectively identified from the computerized database of the Clalit Health Services, which is the largest not-for-profit health maintenance organization in Israel. The CHA2DS2-VASc score was calculated for each subject at study entry. The cohort was followed for the first occurrence of pulmonary embolism until December 31, 2012 (70,210 person-years).
  
  
  RESULTS
  Pulmonary embolism developed in 158 subjects, representing an incidence of 225.0 per 100,000 person-years. The incidence of pulmonary embolism increased with increasing CHA2DS2-VASc score (P < .001). On Cox proportional analysis, CHA2DS2-VASc score was significantly associated with pulmonary embolism (hazard ratio, 1.22; 95% confidence interval [CI], 1.13-1.32) for a 1-point increase in CHA2DS2-VASc score. The results were similar after adjusting for anticoagulants and antiplatelet use (hazard ratio, 1.24; 95% CI, 1.14-1.34), and remained unchanged after further adjustment for active malignancy. The predictive values for pulmonary embolism were similar for CHA2DS2-VASc score and the classic risk stratification score which includes Congestive heart failure, Hypertension, Age >75 years, Diabetes, and Stroke [doubled] (CHADS2); the areas under the receiver operating characteristic curves were 0.619 (95% CI, 0.579-0.660) and 0.616 (95% CI, 0.575-0.656), respectively.
  
  
  CONCLUSIONS
  CHA2DS2-VASc score is directly associated with the incidence of pulmonary embolism in atrial fibrillation.
authors.affiliation: Department of Community Medicine and Epidemiology, Carmel Medical Center, Clalit Health Services, and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Internal Medicine C, Ha'emek Medical Center, Afula, Israel. Electronic address: saliba_wa@clalit.org.il.
authors.forename: Walid
authors.initials: W
authors.lastname: Saliba
authors.affiliation: Department of Community Medicine and Epidemiology, Carmel Medical Center, Clalit Health Services, and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Department of Epidemiology and Disease Prevention, Office of the Chief Physician, Clalit Health Services Headquarters, Tel Aviv, Israel.
authors.forename: Gad
authors.initials: G
authors.lastname: Rennert
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis; D015986:Confounding Factors, Epidemiologic; D048909:Diabetes Complications / Q000453:epidemiology*; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D006973:Hypertension / Q000150:complications*; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011655:Pulmonary Embolism / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000150:complications*; D014652:Vascular Diseases / Q000150:complications*
keywords: Atrial fibrillation; CHA(2)DS(2)-VASc; Mortality; Pulmonary embolism