Efficacy of R2CHA2DS2-VA score for predicting thromboembolism in Thai patients with non-valvular atrial fibrillation

Background There is no data specific to the addition of renal dysfunction and age 50-64 years as risk parameters to the CHA.sub.2DS.sub.2-VA score, which is known as the R.sub.2CHA.sub.2DS.sub.2-VA score, among NVAF patients. Accordingly, the aim of this study was to validate the R.sub.2CHA.sub.2DS....

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Bibliographic Details
Published in:BMC cardiovascular disorders 2021-11, Vol.21 (1), p.1-540, Article 540
Main Authors: Methavigul, Komsing, Sairat, Poom, Krittayaphong, Rungroj
Format: Article
Language:English
Subjects:
Age
Anticoagulant
Anticoagulants (Medicine)
Atrial fibrillation
Calibration
Cardiac arrhythmia
Care and treatment
CHA2DS2-VASc
Clinical medicine
Complications and side effects
Congestive heart failure
Diagnosis
Dosage and administration
Embolism
Embolisms
Fibrillation
Heart failure
Ischemia
Kidney diseases
Kidney failure
Non-valvular atrial fibrillation
NVAF
Patient outcomes
Patients
R2CHA2DS2-VA
Reclassification
Renal function
Risk factors
Sensitivity analysis
Statistics
Stroke
Stroke (Disease)
Thromboembolism
Transient ischemic attack
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Summary:Background There is no data specific to the addition of renal dysfunction and age 50-64 years as risk parameters to the CHA.sub.2DS.sub.2-VA score, which is known as the R.sub.2CHA.sub.2DS.sub.2-VA score, among NVAF patients. Accordingly, the aim of this study was to validate the R.sub.2CHA.sub.2DS.sub.2-VA score for predicting thromboembolism in Thai NVAF patients. Methods Thai NVAF patients were prospectively enrolled in a nationwide multicenter registry from 27 hospitals during 2014-2020. Each component of the CHA.sub.2DS.sub.2-VA and R.sub.2CHA.sub.2DS.sub.2-VA scores was scored and recorded. The main outcomes were thromboembolism, including ischemic stroke, transient ischemic attack (TIA), and/or systemic embolism. The annual incidence rate of thromboembolism among patients in each R.sub.2CHA.sub.2DS.sub.2-VA and CHA.sub.2DS.sub.2-VA risk score category is shown as hazard ratio (HR) and 95% confidence interval (95% CI). The performance of the R.sub.2CHA.sub.2DS.sub.2-VA and CHA.sub.2DS.sub.2-VA scores was demonstrated using c-statistics. Net reclassification index was calculated. Calibration plat was used to assess agreement between observed probabilities and predicted probabilities of both scoring system. Results A total of 3402 patients were enrolled during 2014-2020. The average age of patients was 67.38 [+ or -] 11.27 years. Of those, 46.9% had renal disease, 30.7% had a history of heart failure, and 17.1% had previous stroke or TIA. The average R.sub.2CHA.sub.2DS.sub.2-VA and CHA.sub.2DS.sub.2-VA scores were 3.92 [+ or -] 1.92 and 2.98 [+ or -] 1.43, respectively. Annual thromboembolic risk increased with incremental increase in R.sub.2CHA.sub.2DS.sub.2-VA and CHA.sub.2DS.sub.2-VA scores. Oral anticoagulants had benefit in stroke prevention in NVAF patients with an R.sub.2CHA.sub.2DS.sub.2-VA score of 2 or more (adjusted HR: 0.630, 95% CI 0.413-0.962, p = 0.032). The c-statistics were 0.630 (95% CI 0.61-0.65) and 0.627 (95% CI 0.61-0.64), for R.sub.2CHA.sub.2DS.sub.2-VA and CHA2DS2-VA scores respectively. NRI was 2.2%. The slope and R2 of the calibration plot were 0.73 and 0.905 for R.sub.2CHA.sub.2DS.sub.2-VA and 0.70 and 0.846 for CHA.sub.2DS.sub.2-VA score respectively. Conclusions R.sub.2CHA.sub.2DS.sub.2-VA score was found to be at least as good as CHA.sub.2DS.sub.2-VA score for predicting thromboembolism in Thai patients with NVAF. Similar to CHA.sub.2DS.sub.2-VA score, thromboembolism increased with incremental increase in R.sub.2CHA.sub.2
ISSN:1471-2261
1471-2261
DOI:10.1186/s12872-021-02370-2