Key result
CHA2DS2-VASc and modified-CHADS2 scores showed modest discrimination for events, while stroke strongly predicted cardiovascular death (OR 3.52, 95% CI 1.92-6.47, p<0.01) in haemodialysis patients.
Why the study?
CHA2DS2-VASc and modified-CHADS2 scores easily estimate stroke risk in atrial fibrillation, but their performance and the effect of diabetes mellitus in haemodialysis patients needed evaluation.
Do CHA2DS2-VASc and modified-CHADS2 scores predict cardiovascular events in haemodialysis patients with and without diabetes?
Cohort (n=237)
Do CHA2DS2-VASc and modified-CHADS2 scores predict cardiovascular events in haemodialysis patients with and without diabetes?
p-value: p=<0.01
CHA2DS2-VASc and modified-CHADS2 scores correlate with cardiovascular events and mortality in haemodialysis patients but have modest discrimination and poor calibration.
Stroke history may warrant heightened CV surveillance in haemodialysis; leaves open CHA2DS2-VASc utility for event prediction.
Aim CHA 2 DS 2 ‐VASc and modified‐CHADS 2 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 CHA 2 DS 2 ‐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. CHA 2 DS 2 ‐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‐CHADS 2 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 CHA 2 DS 2 ‐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‐CHADS 2 score correlated with heart failure, cardiovascular and all‐cause mortality only on non‐diabetics. Both had modest discrimination and poor calibration.
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Tourountzis et al. (2023) conducted a cohort in Haemodialysis (n=237). CHA2DS2-VASc and modified-CHADS2 scores was evaluated on Cardiovascular events (acute myocardial infarction, atrial fibrillation, heart failure, peripheral arterial disease, stroke, mortality) (p=<0.01). CHA2DS2-VASc and modified-CHADS2 scores showed modest discrimination for events, while stroke strongly predicted cardiovascular death (OR 3.52, 95% CI 1.92-6.47, p<0.01) in haemodialysis patients.
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