title: CHA2DS2-VASc score and adverse outcomes in patients with heart failure with reduced ejection fraction and sinus rhythm.
abstract: OBJECTIVE
  The aim of this study was to determine whether the CHA2DS2-VASc score can predict adverse outcomes such as death, ischaemic stroke, and major haemorrhage, in patients with systolic heart failure in sinus rhythm.
  
  
  RESULTS
  CHA2DS2-VASc scores were calculated for 1101 patients randomized to warfarin and 1123 patients randomized to aspirin. Adverse outcomes were defined as death or ischaemic stroke, death alone, ischaemic stroke alone, and major haemorrhage. Using proportional hazards models, we found that each 1-point increase in the CHA2DS2-VASc score was associated with increased hazard of death or ischaemic stroke events [hazard ratio (HR) for the warfarin arm = 1.21, 95% confidence interval (CI) 1.13-1.30, P < 0.001; for aspirin, HR = 1.20, 95% CI 1.11-1.29, P < 0.001]. Similar increased hazards for higher CHA2DS2-VASc scores were observed for death alone, ischaemic stroke alone, and major haemorrhage. Overall performance of the CHA2DS2-VASc score was assessed using c-statistics for full models containing the risk score, treatment assignment, and score-treatment interaction, with the c-statistics for the full models ranging from 0.57 for death to 0.68 for major haemorrhage.
  
  
  CONCLUSIONS
  The CHA2DS2-VASc score predicted adverse outcomes in patients with systolic heart failure in sinus rhythm, with modest prediction accuracy.
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA. sy2357@cumc.columbia.edu.
authors.forename: Siqin
authors.initials: S
authors.lastname: Ye
authors.affiliation: Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA.
authors.forename: Min
authors.initials: M
authors.lastname: Qian
authors.affiliation: Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhao
authors.affiliation: Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Buchsbaum
authors.affiliation: Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.affiliation: Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Levin
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: Marco R
authors.initials: MR
authors.lastname: Di Tullio
authors.affiliation: Department of Medicine, Washington University, St. Louis, MO, USA.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Mann
authors.affiliation: Kent Institute of Medicine and Health Sciences, University of Kent, Canterbury, UK.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Pullicino
authors.affiliation: Division of Cardiology, Department of Medicine, Lehigh Valley Hospital, Allentown, PA, USA.
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Freudenberger
authors.affiliation: Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, CA, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Teerlink
authors.affiliation: Department of Neurology, Columbia University Medical Center, New York, NY, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Mohr
authors.affiliation: Division of Cardiology, Department of Medicine, SUNY Upstate Medical University, Buffalo, NY, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Graham
authors.affiliation: Department of Cardiovascular Medicine, University of South Florida, Tampa, FL, USA.
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Labovitz
authors.affiliation: Centro Neurológico de Tratamiento y Rehabilitación, Buenos Aires, Argentina.
authors.forename: Conrado J
authors.initials: CJ
authors.lastname: Estol
authors.affiliation: Department of Cardiology, Deventer Hospital, Deventer, The Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Lok
authors.affiliation: Department of Heart Diseases, Wroclaw Medical University, Military Hospital, Wroclaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
authors.affiliation: Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Centre Göttingen, Göttingen, Germany.
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
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 Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA.
authors.forename: John L P
authors.initials: JL
authors.lastname: Thompson
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D013318:Stroke Volume; D013599:Systole; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D001241:Aspirin
keywords: Bleeding; Heart failure; Sinus rhythm; Stroke; Warfarin