title: CHA2DS2-VASc Score: A Predictor of Thromboembolic Events and Mortality in Patients With an Implantable Monitoring Device Without Atrial Fibrillation.
abstract: To determine if the CHA2DS2-VASc score (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65-74 years, sex category) predicts thromboembolism and death in patients without atrial fibrillation in a population with implantable cardiac monitoring devices.
  
  
  
  A retrospective review utilizing the Rochester Epidemiology Project research infrastructure was conducted to evaluate the CHA2DS2-VASc tool as a predictor of mortality and ischemic stroke, transient ischemic attack, or systemic embolism in patients without atrial fibrillation. An implantable device was required in the inclusion criteria to discern the absence of atrial fibrillation. The study period was January 1, 2004, through March 7, 2016.
  
  
  
  The study population (N=1606) had a mean (SD) age of 69.8 (12.6) years and median follow-up of 4.8 years (range, 0-12 years; quartile 1, 2.6 years and quartile 3, 8.1 years). The number of thromboembolic and mortality events stratified by CHA2DS2-VASc score groupings of 0 to 2 (399 patients), 3 to 5 (756 patients), and 6 to 9 (451 patients) were 12 (3.0%), 109 (14.4%), and 123 (27.3%) and 22 (5.5%), 205 (27.1%), and 214 (47.4%), respectively. The CHA2DS2-VASc score predicted thromboembolism and death. The hazard ratios (HRs) for thromboembolic events for CHA2DS2-VASc scores 3 to 5 and 6 to 9 were 4.84 (95% CI, 2.66-8.80) and 10.53 (95% CI, 5.77-19.21) (reference group, scores 0-2). The HRs for death for the corresponding score categories were 4.45 (95% CI, 2.86-6.91) and 8.18 (95% CI, 5.23-12.78). The CHA2DS2-VASc score also predicted development of atrial fibrillation, for which the HRs for scores 3 to 5 and 6 to 9 were 1.51 (95% CI, 1.13-2.00) and 2.17 (95% CI, 1.60-2.95).
  
  
  
  The CHA2DS2-VASc tool predicts thromboembolic events and overall mortality in patients without atrial fibrillation who have implantable devices.
authors.affiliation: Department of Medicine, Mayo Clinic, Scottsdale, AZ.
authors.forename: Christine
authors.initials: C
authors.lastname: Parsons
authors.affiliation: Department of Medicine, Mayo Clinic, Scottsdale, AZ.
authors.forename: Salma I
authors.initials: SI
authors.lastname: Patel
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ.
authors.forename: Stephen
authors.initials: S
authors.lastname: Cha
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ.
authors.forename: Win-Kuang
authors.initials: WK
authors.lastname: Shen
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ.
authors.forename: Santosh
authors.initials: S
authors.lastname: Desai
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors.forename: Alanna M
authors.initials: AM
authors.lastname: Chamberlain
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
authors.forename: Sushil Allen
authors.initials: SA
authors.lastname: Luis
authors.affiliation: Department of Neurology, Mayo Clinic, Scottsdale, AZ.
authors.forename: Maria I
authors.initials: MI
authors.lastname: Aguilar
authors.affiliation: Department of Neurology, Mayo Clinic, Scottsdale, AZ.
authors.forename: Bart M
authors.initials: BM
authors.lastname: Demaerschalk
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ.
authors.forename: Farouk
authors.initials: F
authors.lastname: Mookadam
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ. Electronic address: Shamoun.Fadi@mayo.edu.
authors.forename: Fadi
authors.initials: F
authors.lastname: Shamoun
mesh_terms: D017677:Age Distribution; D000368:Aged; D000925:Anticoagulants / Q000592:standards* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data; D048909:Diabetes Complications / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D017678:Sex Distribution; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality; D013923:Thromboembolism / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D014652:Vascular Diseases / Q000453:epidemiology
chemical_list: D000925:Anticoagulants