CHA ₂ DS ₂ ‐VASc Score and the Risk of Ventricular Tachyarrhythmic Events and Mortality in MADIT‐CRT

Background We hypothesized that multiple cardiovascular comorbidities, incorporated in the CHA 2 DS 2 ‐ VAS c score, may be useful in the assessment of ventricular tachyarrhythmias ( VTAs ) and mortality risk in heart failure ( HF ) patients. Methods and Results We evaluated the association between the CHA 2 DS 2 ‐ VAS c score (dichotomized as high at the upper quartile [≥5] and further assessed as a continuous measure) and the risk of VTA and death among 1804 patients enrolled in MADIT‐CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy). A high CHA 2 DS 2 ‐ VAS c score (n=464; 26%) was inversely associated with the risk of any VTA (hazard ratio [ HR ]: 0.64; P =0.001), fast VTA >200 beats/min ( HR ; 0.51; P <0.001), and appropriate implantable cardioverter‐defibrillator shocks ( HR : 0.60; P <0.001). In contrast, a high score was directly correlated with mortality risk (HR: 1.92; P <0.001) and the risk of HF or death ( HR : 1.60; P <0.001). Consistently, each 1‐U increment in CHA 2 DS 2 ‐ VAS c was associated with a significant 13% ( P =0.003) reduction in VTA risk but a corresponding 33% ( P <0.001) increase in mortality risk. Patients with a high CHA 2 DS 2 ‐ VAS c score and left bundle‐branch block derived a pronounced 53% ( P <0.001) reduction in the risk of HF or death with cardiac resynchronization therapy with defibrillator versus implantable cardioverter‐defibrillator–only therapy. Conclusions Our findings suggest that a high CHA 2 DS 2 ‐ VAS c score can be used to identify patients with mild HF who have low VTA risk and high morbidity or mortality risk and may derive a pronounced clinical benefit from cardiac resynchronization therapy without a defibrillator. These data suggest a possible role for the CHA 2 DS 2 ‐ VAS c score in device selection among candidates for biventricular pacing.