Your browser doesn't support javascript.
loading
Arterial Thromboembolism in Patients With Atrial Fibrillation and CHA2DS2-VASc Score 1: A Nationwide Study.
Østergaard, Lauge; Olesen, Jonas Bjerring; Petersen, Jeppe Kofoed; Nielsen, Lukas Schak; Kristensen, Søren Lund; Schou, Morten; Køber, Lars; Fosbøl, Emil.
Affiliation
  • Østergaard L; The Heart Center, Rigshospitalet (L.Ø., J.K.P., L.S.N., S.L.K., L.K., E.F.), University of Copenhagen, Denmark.
  • Olesen JB; Department of Cardiology, Herlev-Gentofte Hospital (J.B.O., M.S.), University of Copenhagen, Denmark.
  • Petersen JK; The Heart Center, Rigshospitalet (L.Ø., J.K.P., L.S.N., S.L.K., L.K., E.F.), University of Copenhagen, Denmark.
  • Nielsen LS; The Heart Center, Rigshospitalet (L.Ø., J.K.P., L.S.N., S.L.K., L.K., E.F.), University of Copenhagen, Denmark.
  • Kristensen SL; The Heart Center, Rigshospitalet (L.Ø., J.K.P., L.S.N., S.L.K., L.K., E.F.), University of Copenhagen, Denmark.
  • Schou M; Department of Cardiology, Herlev-Gentofte Hospital (J.B.O., M.S.), University of Copenhagen, Denmark.
  • Køber L; The Heart Center, Rigshospitalet (L.Ø., J.K.P., L.S.N., S.L.K., L.K., E.F.), University of Copenhagen, Denmark.
  • Fosbøl E; The Heart Center, Rigshospitalet (L.Ø., J.K.P., L.S.N., S.L.K., L.K., E.F.), University of Copenhagen, Denmark.
Circulation ; 149(10): 764-773, 2024 03 05.
Article in En | MEDLINE | ID: mdl-38152890
ABSTRACT

BACKGROUND:

Oral anticoagulation is suggested in patients with atrial fibrillation and a CHA2DS2-VASc score ≥1 (congestive heart failure, hypertension, age ≥75 years, diabetes, stroke, vascular disease, age 65-74 years, and sex score). To assess granular differences within CHA2DS2-VASc 1, the incidence of arterial thromboembolism according to CHA2DS2-VASc 1 subgroups was examined.

METHODS:

The Danish National Patient Registry and the Danish Prescription Registry were linked on a nationwide level to identify patients with atrial fibrillation from 2000 to 2021 without oral anticoagulation and categorized according to CHA2DS2-VASc score CHA2DS2-VASc 0 (male and female subjects); CHA2DS2-VASc 1 (hypertension, heart failure, diabetes, vascular disease, and age 65-74 years); or CHA2DS2-VASc 2 (age ≥75 years without other risk factors). Female sex was not considered a risk factor in any risk group. The outcome was arterial thromboembolism (ischemic stroke, embolism of extremity, or transient cerebral ischemia). Study groups were compared using Cox regression analysis.

RESULTS:

We included 26 701 patients with a CHA2DS2-VASc 0 score; 22 915 with CHA2DS2-VASc 1 (1483 patients with heart failure, 9066 with hypertension, 843 with diabetes, 770 with vascular disease, and 10 753 who were 65 to 74 years of age); and 14 525 patients with CHA2DS2-VASc 2 (≥75 years of age without other risk factors). With a median of 1 year of observation time, the cumulative incidence of arterial thromboembolism was 0.6% (n=154 [95% CI, 0.6%-0.8%]), 1.4% (n=16 [95% CI, 0.8%-2.2%]), 1.9% (n=141 [95% CI, 1.6%-2.2%]), 1.7% (n=12 [95% CI, 0.9%-2.9%]), 2.0% (n=13 [95% CI, 1.1%-3.4%]), 2.3% (n=187 [95% CI, 2.0%-2.7%]), and 4.4% (n=533 [95% CI, 4.1%-4.8%]) for CHA2DS2-VASc 0, heart failure, hypertension, diabetes, vascular disease, age 65 to 74 years (CHA2DS2-VASc 1), and age ≥75 years (CHA2DS2-VASc 2), respectively. No statistically significant difference was identified among subgroups of CHA2DS2-VASc 1 (P=0.15 for difference).

CONCLUSIONS:

For patients with atrial fibrillation, all subgroups of CHA2DS2-VASc 1 were associated with lower incidence of arterial thromboembolism compared with age ≥75 years without other risk factors (ie, CHA2DS2-VASc 2) and a higher incidence compared with CHA2DS2-VASc 0. No statistically significant difference was identified between the subgroups of CHA2DS2-VASc 1. These findings support current recommendations that patients within this intermediate risk group could be identified with a similar risk of arterial thromboembolism.
Subject(s)
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Atrial Fibrillation / Thromboembolism / Stroke / Diabetes Mellitus / Heart Failure / Hypertension Limits: Aged / Female / Humans / Male Language: En Journal: Circulation Year: 2024 Type: Article Affiliation country: Denmark

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Atrial Fibrillation / Thromboembolism / Stroke / Diabetes Mellitus / Heart Failure / Hypertension Limits: Aged / Female / Humans / Male Language: En Journal: Circulation Year: 2024 Type: Article Affiliation country: Denmark