Prediction of acute coronary syndrome, ischemic stroke, and mortality in patients with heart failure: a comparison of CHA2DS2-VASc and AHEAD scores
To compare the predictive capacity of the CHA2DS2-VASc and AHEAD scores in predicting acute coronary syndrome (ACS), ischemic stroke (IS), and mortality in patients with heart failure (HF).
A total of 404,635 patients hospitalized for HF between 2000 and 2011 were recruited from a large national database in Taiwan. The predictive value of both scores was evaluated by analysis of the area under the receiver operating characteristic curve (AUROC), and the difference in their discriminative capacity was assessed using the DeLong test.
The AUROC for the CHA2DS2-VASc score was significantly higher than that for the AHEAD score in predicting ACS and IS: 0.53 (95% CI = 0.53–0.54) versus 0.51 (95% CI = 0.51–0.52) for ACS, and 0.57 (95% CI = 0.56–0.57) versus 0.52 (95% CI = 0.51–0.52) for IS, respectively (all DeLong tests p < 0.001). By contrast, for mortality risk, the AUROC was significantly lower for the CHA2DS2-VASc score (0.56, 95% CI = 0.55–0.56) than the AHEAD score (0.60, 95% CI = 0.59–0.60; DeLong test p < 0.001).
The ability of the CHA2DS2-VASc score to predict macrovascular complications (ACS and IS) in HF patients was higher than that of AHEAD.
KeywordsAcute coronary syndrome AHEAD score CHA2DS2-VASc score Heart failure Ischemic stroke Mortality
This study was supported in part by the Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW106-TDU-B-212-113004).
- 2.Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation. 2012;125:e2–e220.Google Scholar
- 5.Chen YJ, Sung SH, Cheng HM, Huang WM, Wu CL, Huang CJ, Hsu PF, Yeh JS, Guo CY, Yu WC, Chen CH. Performance of AHEAD score in an Asian cohort of acute heart failure with either preserved or reduced left ventricular systolic function. J Am Heart Assoc. 2017;6(5).Google Scholar
- 6.Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. J Am Coll Cardiol. 2011;57(11):e101–98.CrossRefGoogle Scholar
- 11.Database NHIR. Taiwan, http://nhird.nhri.org.tw/en/index.html.
- 13.Harnod T, Lin CL, Kao CH. Risk of suicide attempt in poststroke patients: a population-based cohort study. J Am Heart Assoc J Am Heart Assoc. 2018;7(2).Google Scholar
- 16.January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;64:e1–76.CrossRefGoogle Scholar
- 17.Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, et al. 2012 focused update of the ESC guidelines for the management of atrial fibrillation: an update of the 2010 ESC guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J. 2012;33:2719–47.CrossRefGoogle Scholar