CHA2DS2-VASc score as a mortality predictor in acute heart failure with preserved ejection fraction

Background The mortality rate in decompensated heart failure (HF) with preserved ejection fraction (HFpEF) remains high. In recent years the prognostic role of CHA 2 DS 2 -VASc score, initially formulated for embolic risk prediction in atrial fibrillation, has been shown in other diseases including HF. We sought to analyze a long-term mortality in decompensated HFpEF patients depending on CHA 2 DS 2 -VASc score. Methods 261 (22.74%) out of 1,148 patients included in the single-center Lesser Poland Cracovian Heart Failure (LECRA-HF) Registry between 2009 and 2022 were diagnosed with decompensated HFpEF. We identified 213 (81.61%) subjects with CHA₂DS₂-VASc score ≥4 points and 48 (18.39%) < 4 points. Results Patients with CHA₂DS₂-VASc ≥4 were older (79 vs. 64 years, P < 0.001), mostly females (65.3% vs. 27.1%, P < 0.001), and were characterized by atrial fibrillation (62.9% vs. 31.3%, P < 0.001), prior myocardial infarction (24.4% vs. 6.3%, P = 0.005), percutaneous coronary intervention (23.0% vs. 4.2%, P = 0.003) and coronary artery bypass surgery (11.3% vs. 2.1%, P = 0.049) compared to CHA 2 DS 2 -VASc <4 cohort. Lower baseline GFR (by 26.7%, P < 0.001), potassium (by 4.4%, P = 0.02), hemoglobin (by 10.3%, P < 0.001), as well as hematocrit (by 8.1%, P = 0.003) were noted in CHA 2 DS 2 -VASc ≥4 patients. In a long-term follow-up (median 4.3 years), overall mortality was significantly higher in CHA 2 DS 2 -VASc ≥4 group ( P = 0.005) and CHA 2 DS 2 -VASc ≥4 was its independent predictor (HR 3.54, 95% confidence interval 1.68–7.49). In a multivariable Cox regression analysis, each one-point increase in CHA 2 DS 2 -VASc score raised all-cause mortality risk by 32%. Conclusions As has been shown for the first time CHA 2 DS 2 -VASc score was an independent prognostic parameter in decompensated HFpEF.