Format

Send to

Choose Destination
Heart Rhythm. 2018 Jul;15(7):971-979. doi: 10.1016/j.hrthm.2018.02.023. Epub 2018 Mar 1.

Does the CHA2DS2-VASc score reliably predict atrial arrhythmias? Analysis of a nationwide database of remote monitoring data transmitted daily from cardiac implantable electronic devices.

Author information

1
Ospedale San Gerardo, Monza, Italy. Electronic address: gi.rovaris@tin.it.
2
Clinica Montevergine, Mercogliano (AV), Italy.
3
Ospedale Monaldi, Napoli, Italy.
4
Ospedale Mater Salutis, Legnago, Italy.
5
Roma, Italy.
6
Ospedale Vito Fazzi, Lecce, Italy.
7
Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy.
8
Ospedale San Raffaele, Milano, Italy.
9
Azienda Ospedaliera Pugliese Ciaccio, Catanzaro, Italy.
10
Ospedale di Ciriè, Ciriè (TO), Italy.
11
Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
12
Policlinico Sant'Orsola-Malpighi, Bologna, Italy.
13
Spedali Civili, Brescia, Italy.
14
Policlinico Vittorio Emanuele PO Ferrarotto, Catania, Italy.
15
Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy.
16
Fondazione di Ricerca e Cura Giovanni Paolo II, Campobasso, Italy.
17
Clinica di Cardiologia, Università Politecnica Marche, Ancona, Italy.
18
Ospedale Maria Vittoria, Torino, Italy.
19
AOU S.Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy.
20
Ospedale di Circolo e Fond. Macchi, Varese, Italy.
21
BIOTRONIK Italia, Vimodrone (MI), Italy.

Abstract

BACKGROUND:

CHA2DS2-VASc is a validated score for predicting stroke in patients with atrial fibrillation (AF).

OBJECTIVE:

The purpose of this study was to assess whether the CHA2DS2-VASc score can predict new-onset AF in a cohort of patients with a cardiac implantable electronic device (CIED) followed with remote monitoring.

METHODS:

Using the database of the Home Monitoring Expert Alliance project, we selected 2410 patients with no documented AF who had received a CIED with diagnostics on atrial high rate episodes (AHREs). The primary endpoint was time to first day with cumulative AHRE burden ≥15 minutes, 5 hours, 24 hours, and ≥7 consecutive days.

RESULTS:

During a median duration of 24.1(11.5-42.9) months, the incidence of AHRE increased with increasing CHA2DS2-VASc. At 6 years, occurrence of ≥15-minute AHRE was 80.2% (CHA2DS2-VASc ≤1) vs 93.7% (CHA2DS2-VASc ≥5), whereas ≥5-hour AHRE incidence was 68.4% (CHA2DS2-VASc ≤1) vs 92.5% (CHA2DS2-VASc ≥5). Occurrence of ≥24-hour and ≥7-day AHREs also increased with increasing CHA2DS2-VASc: 9.1% and 3.9% (CHA2DS2-VASc ≤1) vs 40.4% and 28.7% (CHA2DS2-VASc ≥5), respectively. Adjusted hazard ratio for unitary CHA2DS2-VASc increase ranged from 1.09 (confidence interval 1.04-1.14; P <.001) with AHRE burden ≥15 minutes to 1.26 (confidence interval 1.11-1.42; P <.001) with AHRE burden ≥7 days. At receiver operating curve analysis, CHA2DS2-VASc ≥2 was estimated to predict persistent forms of AHREs with 95.8% sensitivity but 11.7% specificity at 3 years. CHA2DS2-VASc ≥5 had 77.0% specificity but 34.6% sensitivity.

CONCLUSION:

In a CIED population with no previous diagnosis of clinical AF, AHRE incidence increased with increasing CHA2DS2-VASc score. The association was stronger with longer AHREs, but the accuracy of CHA2DS2-VASc as AHRE predictor was moderate.

KEYWORDS:

Atrial fibrillation; CHA(2)DS(2)-VASc score; Cardiac implantable electronic device; Clinical predictor; Remote monitoring

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center