title: Thromboembolic risk stratification of patients hospitalized with heart failure in sinus rhythm: a nationwide cohort study.
abstract: OBJECTIVE
  Patients with heart failure in sinus rhythm are at an increased risk of thromboembolic complications. So far, validated risk stratification tools are lacking for such patients, which makes the decision to initiate anti-thrombotic treatment difficult.
  
  
  RESULTS
  We included 136,545 patients admitted with heart failure in sinus rhythm from national registries from 1999 to 2012. Patients receiving oral anticoagulants were omitted from the study. First, we investigated if the CHA2DS2-VASc score could identify heart failure patients in sinus rhythm with high rates of thromboembolic complications. Second, we investigated if any single CHA2DS2-VASc risk factor carried a greater prognostic value with regard to thromboembolism. The risk of thromboembolism increased more than ninefold (hazard ratio 9.2, 95% confidence interval 6.8-12.5) in patients with all CHA2DS2-VASc risk factors compared with those with heart failure alone. The incidence rates of thromboembolism were clinically significant, averaging 6.0 (95% confidence interval 5.98-6.02) events per 100 patient years during the first year following diagnosis. Risk factors such as diabetes, age, vascular disease, and especially previous thromboembolism, conferred an independent risk of future thromboembolism.
  
  
  CONCLUSIONS
  The CHA2DS2-VASc risk stratification scheme was able to provide prognostic information on future thromboembolic events in patients with heart failure in sinus rhythm. The CHA2DS2-VASc scale could be easily implemented as an aid to clinicians in risk stratifying heart failure patients in sinus rhythm, for thromboembolism.
authors.affiliation: Department of Cardiology, Gentofte Hospital, University of Copenhagen, Gentofte, Denmark.
authors.forename: Emil
authors.initials: E
authors.lastname: Wolsk
authors.affiliation: Department of Cardiology, Gentofte Hospital, University of Copenhagen, Gentofte, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Lamberts
authors.affiliation: Department of Cardiology, Gentofte Hospital, University of Copenhagen, Gentofte, Denmark.
authors.forename: Morten L
authors.initials: ML
authors.lastname: Hansen
authors.affiliation: Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Paul
authors.initials: P
authors.lastname: Blanche
authors.affiliation: The Heart Centre, Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.affiliation: Institute of Health, Science and Technology, Aalborg University, Aalborg, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.affiliation: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.affiliation: Department of Cardiology, Gentofte Hospital, University of Copenhagen, Gentofte, Denmark.|The National Institute of Public Health, University of Southern Denmark, Odense, Denmark.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Gislason
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D048909:Diabetes Complications; D005260:Female; D005544:Forecasting; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology*; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012306:Risk; D012307:Risk Factors; D012737:Sex Factors; D013923:Thromboembolism / Q000209:etiology*; D014652:Vascular Diseases / Q000150:complications
keywords: CHA2DS2-VASc; Cerebral infarction; Heart failure; Sinus rhythm; Stroke; Thromboembolism