Usefulness of CHADS₂ and CHA₂DS₂-VASc Scores in the Prediction of New-Onset Atrial Fibrillation: A Population-Based Study

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• 作者：Walid Saliba ; MD ; MPH^a ; ^{saliba_wa@clalit.org.il" class="auth_mail" title="E-mail the corresponding author} ; Naomi Gronich ; MD^a ; Ofra Barnett-Griness ; PhD^a ; Gad Rennert ; MD ; PhD^a ; ^b
• 关键词：Atrial fibrillation ; CHADS2 score ; CHA2DS2-VASc score ; Clinical prediction rule
• 刊名：The American Journal of Medicine
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：129
• 期：8
• 页码：843-849
• 全文大小：617 K

文摘

CHADS₂ and CHA₂DS₂-VASc are validated scores used to predict stroke in patients with atrial fibrillation. Many of the individual risk factors included in these scores are also risk factors for atrial fibrillation. We aimed to examine the performance of CHADS₂ and CHA₂DS₂-VASc scores in predicting new-onset atrial fibrillation in subjects without preexisting diagnosis of atrial fibrillation.

Methods

Using the computerized database of the largest health maintenance organization in Israel, we identified all adults aged 50 years or older without atrial fibrillation prior to January 1, 2012. CHADS₂ and CHA₂DS₂-VASc scores were calculated for each participant at study entry, and the cohort was followed for incident atrial fibrillation until December 31, 2014.

Results

Of 1,062,073 subjects without preexisting diagnosis of atrial fibrillation; 23,223 developed atrial fibrillation during a follow-up of 3,053,754 person-years (incidence rate, 0.76 per 100 person-years). Incidence rate of atrial fibrillation increased in a graded manner with increasing CHA₂DS₂-VASc score: 0.17, 0.21, 0.49, 0.94, 1.65, 2.31, 2.75, 3.39, 4.09, and 6.71 per 100 person-years for CHA₂DS₂-VASc score of 0 to 9 points, respectively (P < .001). The hazard ratio for atrial fibrillation for each 1-point increase in CHA₂DS₂-VASc score was 1.57 (95% confidence interval [CI], 1.56-1.58). Results were similar for CHADS₂ score. The area under the receiver operating characteristic curve to predict new-onset atrial fibrillation was 0.728 (95% CI, 0.725-0.711) and 0.744 (95% CI, 0.741-0.747) for CHADS₂ and CHA₂DS₂-VASc scores, respectively.

Conclusions

CHADS₂ and CHA₂DS₂-VASc scores are directly associated with the incidence of new-onset atrial fibrillation, and have a relatively high performance for atrial fibrillation prediction.