Stroke risk scores to predict hospitalization for acute decompensated heart failure in atrial fibrillation patients

Introduction. Atrial fibrillation (AF) is the most frequent hospitalized arrhythmia. It associates increased risk of death, stroke and heart failure (HF). Stroke risk scores, especially CHA 2 DS 2 -VASc, have been applied also for populations with different diseases. There is, however, limited data focusing on the ability of these scores to predict HF decompensation. Methods. We conducted a retrospective observational study on a cohort of 204 patients admitted for cardiovascular pathology to the Cardiology Ward of our tertiary University Hospital. We aimed to determine whether the stroke risk scores could predict hospitalisations for acute decompensated HF in AF patients. Results. C-statistics for CHADS 2 and R 2 CHADS 2 showed a modest predictive ability for hospitalisation with decompensated HF (CHADS 2 : AUC 0.631 p = 0.003; 95%CI 0.560–0.697. R 2 CHADS 2 : AUC 0.619; 95%CI 0.548–0.686; p = 0.004), a marginal correlation for CHA 2 DS 2- VASc (AUC 0.572 95%CI 0.501-0.641 with a p value of only 0.09, while the other scores failed to show a correlation. A CHADS 2 ≥ 2 showed a RR = 2.96, p<0.0001 for decompensated HF compared to a score <2. For R 2 CHADS 2 ≥ 2, RR = 2.41, p = 0.001 compared to a score <2. For CHA 2 DS 2- VASc ≥ 2 RR = 2.18 p = 0.1, compared to CHA 2 DS 2 -VASc <2. The correlation coefficients showed a weak correlation for CHADS 2 (r = 0.216; p = 0.001) and even weaker for R 2 CHADS 2 (r = 0.197; p = 0.0047 and CHA 2 DS 2 -VASc (r = 0.14; p = 0.035). Conclusions. Among AF patients, CHADS 2, CHA 2 DS 2 -VASc and R 2 CHADS 2 were associated with the risk of hospitalisation for decompensated HF while ABC and ATRIA failed to show an association. However, predictive accuracy was modest and the clinical utility for this outcome remains to be determined.