Cardiovascular Events and Mortality in Patients on Hemodialysis: The Prognostic Value of the CHA2DS2-VASc Score.

Background and Objectives: Cardiovascular events are the major cause of morbidity and mortality in patients on hemodialysis (HD). Identifying risk factors can help in the effort to reduce cardiovascular risk and improve life expectancy. The objective of this study was to evaluate the ability of the CHA2DS2-VASc score-the risk index of stroke in atrial fibrillation (AF)-to predict strokes, major cardiovascular events, and mortality in patients with end-stage kidney disease. Materials and Methods: The CHA2DS2-VASc and HAS-BLED scores (the bleeding risk from the use of anticoagulation in AF) were calculated in 237 HD patients, 99 women with a median age of 76 (15) years, at the time they commenced HD. The scores' ability to predict long term cardiovascular morbidity and mortality was estimated, both in those with and without AF. Among the exclusion criteria were the change of dialysis method or loss of follow-up, HD due to acute renal failure, and incompliance with medical instructions, thus the sample is not representative of a broader population. Results: The CHA2DS2-VASc score was higher in AF (n = 69) compared to non-AF (n = 168) patients, 5 (2.5) vs. 4 (2), p < 0.0001, respectively. An increased CHA2DS2-VASc score was correlated with cardiovascular events, namely, heart failure (p = 0.007, p = 0.024), stroke (p < 0.0001, p < 0.0001), and risk of all-cause mortality (p < 0.0001, p < 0.0001) in AF and non-AF groups, respectively. The C statistics indicated that the referred score showed modest discrimination in AF and non-AF patients on HD for heart failure, stroke, and all-cause mortality, however for cardiovascular mortality this was found only in the AF group. Conclusions: An increased CHA2DS2-VASc score at the time of HD initiation can predict strokes, heart failure, and all-cause mortality in HD patients independent of the presence of AF. The risk of cardiovascular mortality could only be predicted in patients with AF.

The prognostic value of CHA2 DS2 -VASc and modified-CHADS2 scores for cardiovascular events in diabetics and non-diabetics haemodialysis patients.

AIM: CHA2 DS2 -VASc and modified-CHADS2 score can easily estimate the risk of stroke in atrial fibrillation. Study's purpose was to evaluate these in haemodialysis patients, and assess the effect of diabetes mellitus (DM). METHODS: The scores calculated in 237 haemodialysis patients, 121 diabetics (58 females) and 116 non-diabetics (41 females). Results correlated to cardiovascular events (acute myocardial infarction, atrial fibrillation, heart failure, peripheral arterial disease, stroke, mortality). RESULTS: CHA2 DS2 -VASc score correlated with the occurrence of stroke and heart failure (p < .01, p < .01), (p < .01, p < .01), respectively in diabetics and non-diabetics. CHA2 DS2 -VASc score could predict the risk of all-cause mortality in both groups, p = .03, p < .01, respectively, however, the risk of cardiovascular death could be predicted in non-diabetics, p < .01. Modified-CHADS2 score associated with heart failure (p = .04), cardiovascular (p < .01) and all-cause mortality (p < .01) only on non-diabetics. C statistics indicated that the first score showed modest discrimination in patients with and without DM, for stroke and all-cause mortality. The second score performed modestly only on patients without DM for all-cause mortality. Both scores showed poor calibration. Stroke was a common cause of cardiovascular death (OR = 3.52, 95% CI = 1.92-6.47, p < .01) and associated with central venous catheter (OR = 2.19, 95% CI = 1.12-4.27, p = .02) and pre-existing atrial fibrillation (OR = 1.94, 95% CI = 1.06-3.58, p = .03). CONCLUSION: CHA2 DS2 -VASc score correlated with stroke, heart failure and all-cause mortality in haemodialysis patients with and without DM. The risk of cardiovascular death could be predicted only in non-diabetics patients. Modified-CHADS2 score correlated with heart failure, cardiovascular and all-cause mortality only on non-diabetics. Both had modest discrimination and poor calibration.

High prevalence of subclinical peripheral artery disease in Greek hospitalized patients.

BACKGROUND: Peripheral artery disease (PAD) represents a common manifestation of systemic atherosclerosis that is associated with an increased risk of cardiovascular death and ischemic events but one that may be underdiagnosed in clinical practice. The purpose of this study was to identify PAD using the ankle-brachial index (ABI) in hospitalized patients from a Department of Internal Medicine and to further investigate the association of this index with traditional cardiovascular risk factors. METHODS: We measured ABI in 990 consecutive patients (400 men and 590 women) aged 50 years or older (71.2+/-9.1) without a history or symptoms suggestive of PAD. ABI values below 0.90 were considered abnormal. RESULTS: PAD was detected in 356 patients (36%), and men had a higher prevalence than women (p<0.001). Hypertension (p<0.001), smoking (p<0.001), diabetes (p<0.05), male sex (p<0.001), and dyslipidemia (p<0.05) were statistically more frequent in patients with PAD, whereas obesity had no significant relation to PAD in our series. In a stepwise, logistic regression analysis, hypertension, male sex, diabetes mellitus, smoking, and dyslipidemia were found to be independent risk factors with odds ratios (95% confidence intervals) of 2.46 (1.85-3.27), 2.25 (1.66-3.05), 1.80 (1.32-2.47), 1.78 (1.31-2.42), and 1.64 (1.22-2.19), respectively. CONCLUSIONS: A simple ABI measurement revealed a large number of patients with unrecognized PAD. It is, therefore, recommended that ABI measurement should be included in the evaluation of cardiovascular risk in hospitalized patients aged 50 years or older.