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

ABSTRACT

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.