Prognostic value of CHA2DS2-VASc score in patients with ‘non-valvular atrial fibrillation’ and valvular heart disease: the Loire Valley Atrial Fibrillation Project
Abstract
AIMS: The CHA2DS2VASc score is a clinical risk stratification tool which estimates the risk of stroke and thromboembolism in non-valvular atrial fibrillation (AF). We aimed to establish the value of this score for risk evaluation in patients with non-valvular AF and valvular heart disease. METHODS AND RESULTS: Among 8053 patients with non-valvular AF (ESC guidelines definition), patients were categorized into Group 1 (no valve disease, n = 6851; 85%) and Group 2 (valve disease with neither rheumatic mitral stenosis nor valve prothesis, n = 1202; 15%). After follow-up of 868 ± 1043 days, 627 stroke/ thromboembolic (TE) events were recorded. Group 2 was significantly older, had a higher CHA2DS2VASc score and had a higher risk of thromboembolic events [hazard ratio (HR) 1.39; 95% CI 1.14-1.69, P = 0.001] compared with Group 1. Severe valve disease was not associated with worse prognosis for stroke/TE events. In the two groups, stroke/TE risk increased with a higher CHA2DS2VASc score. Factors independently associated with increased risk of stroke/TE events were older age (HR 1.25, 95% CI 1.14-1.36 per 10-year increase, P < 0.0001) and higher CHA2DS2VASc score (HR 1.33, 95% CI 1.23-1.45, P < 0.0001). The predictive value (c-statistic) of the CHA2DS2VASc score was similar in the two groups. CONCLUSION: In patients with non-valvular AF, left-sided valvular heart disease (excluding mitral stenosis and protheses) was associated with an increased risk of stroke/TE events. A higher CHA2DS2VASc score in these patients is likely to explain these results.
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NOACs appear to be equally effective as VKAs in patients with moderate aortic stenosis, based on a subanalysis from the ROCKET-AF trial as well as the Loire Valley AF project.
“NOACs appear to be equally effective as VKAs in patients with moderate aortic stenosis, based on a subanalysis from the ROCKET-AF (Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation) trial 1032 as well as the Loire Valley AF project.1033”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [1033]
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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Self-citation
- Authors
- Philippart, R., Brunet-Bernard, A., Clementy, N., Bourguignon, T., Mirza, A., Babuty, D., Angoulvant, D., Lip, G. Y. H., & Fauchier, L.
- Affiliations
- Université de Tours (FR)
- University of Liverpool (GB)
- Corresponding author
- Fauchier, Laurent
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-05-20
- Volume
- 36
- Issue
- 28
- Pages
- 1822.2-1830
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2158604698
- Cited by
- 68
- References
- 25
- Citations by year
- 2025: 10 · 2024: 3 · 2023: 6 · 2022: 5 · 2021: 9 · 2020: 6 · 2019: 4 · 2018: 2 · 2017: 6 · 2016: 12 · 2015: 5
- FWCI
- 6.11
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Keywords
- CHA2DS2-VASc score, non-valvular atrial fibrillation, valvular heart disease, stroke risk, thromboembolism, risk stratification, mitral stenosis, age as risk factor
- MeSH terms
- Aged, Atrial Fibrillation, Female, Heart Valve Diseases, Humans, Male, Prognosis, Severity of Illness Index, Thromboembolism, Risk Assessment, Stroke, Kaplan-Meier Estimate
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