CHA2DS2-VASc Score and the Risk of Ventricular Tachyarrhythmic Events and Mortality in MADIT-CRT

Eyal Nof, Valentina Kutyifa, Scott McNitt, Jeffrey Goldberger, David Huang, Mehmet K. Aktas, Rosero Spencer, Ilan Goldenberg, Roy Beinart

Research output: Contribution to journalArticle

Abstract

Background We hypothesized that multiple cardiovascular comorbidities, incorporated in the CHA2DS2-VASc score, may be useful in the assessment of ventricular tachyarrhythmias (VTAs) and mortality risk in heart failure (HF) patients. Methods and Results We evaluated the association between the CHA2DS2-VASc score (dichotomized as high at the upper quartile [≥5] and further assessed as a continuous measure) and the risk of VTA and death among 1804 patients enrolled in MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy). A high CHA2DS2-VASc score (n=464; 26%) was inversely associated with the risk of any VTA (hazard ratio [HR]: 0.64; P=0.001), fast VTA >200 beats/min (HR; 0.51; P<0.001), and appropriate implantable cardioverter-defibrillator shocks (HR: 0.60; P<0.001). In contrast, a high score was directly correlated with mortality risk (HR: 1.92; P<0.001) and the risk of HF or death (HR: 1.60; P<0.001). Consistently, each 1-U increment in CHA2DS2-VASc was associated with a significant 13% (P=0.003) reduction in VTA risk but a corresponding 33% (P<0.001) increase in mortality risk. Patients with a high CHA2DS2-VASc score and left bundle-branch block derived a pronounced 53% (P<0.001) reduction in the risk of HF or death with cardiac resynchronization therapy with defibrillator versus implantable cardioverter-defibrillator-only therapy. Conclusions Our findings suggest that a high CHA2DS2-VASc score can be used to identify patients with mild HF who have low VTA risk and high morbidity or mortality risk and may derive a pronounced clinical benefit from cardiac resynchronization therapy without a defibrillator. These data suggest a possible role for the CHA2DS2-VASc score in device selection among candidates for biventricular pacing.

Original languageEnglish (US)
Pages (from-to)e014353
JournalJournal of the American Heart Association
Volume9
Issue number1
DOIs
StatePublished - Jan 7 2020

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Cardiac Resynchronization Therapy
Defibrillators
Tachycardia
Mortality
Heart Failure
Implantable Defibrillators
Bundle-Branch Block
Risk Reduction Behavior
Comorbidity
Shock
Odds Ratio
Morbidity
Equipment and Supplies

Keywords

  • CHA2DS2‐VASc
  • mortality
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

CHA2DS2-VASc Score and the Risk of Ventricular Tachyarrhythmic Events and Mortality in MADIT-CRT. / Nof, Eyal; Kutyifa, Valentina; McNitt, Scott; Goldberger, Jeffrey; Huang, David; Aktas, Mehmet K.; Spencer, Rosero; Goldenberg, Ilan; Beinart, Roy.

In: Journal of the American Heart Association, Vol. 9, No. 1, 07.01.2020, p. e014353.

Research output: Contribution to journalArticle

Nof, E, Kutyifa, V, McNitt, S, Goldberger, J, Huang, D, Aktas, MK, Spencer, R, Goldenberg, I & Beinart, R 2020, 'CHA2DS2-VASc Score and the Risk of Ventricular Tachyarrhythmic Events and Mortality in MADIT-CRT', Journal of the American Heart Association, vol. 9, no. 1, pp. e014353. https://doi.org/10.1161/JAHA.119.014353
Nof, Eyal ; Kutyifa, Valentina ; McNitt, Scott ; Goldberger, Jeffrey ; Huang, David ; Aktas, Mehmet K. ; Spencer, Rosero ; Goldenberg, Ilan ; Beinart, Roy. / CHA2DS2-VASc Score and the Risk of Ventricular Tachyarrhythmic Events and Mortality in MADIT-CRT. In: Journal of the American Heart Association. 2020 ; Vol. 9, No. 1. pp. e014353.
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abstract = "Background We hypothesized that multiple cardiovascular comorbidities, incorporated in the CHA2DS2-VASc score, may be useful in the assessment of ventricular tachyarrhythmias (VTAs) and mortality risk in heart failure (HF) patients. Methods and Results We evaluated the association between the CHA2DS2-VASc score (dichotomized as high at the upper quartile [≥5] and further assessed as a continuous measure) and the risk of VTA and death among 1804 patients enrolled in MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy). A high CHA2DS2-VASc score (n=464; 26{\%}) was inversely associated with the risk of any VTA (hazard ratio [HR]: 0.64; P=0.001), fast VTA >200 beats/min (HR; 0.51; P<0.001), and appropriate implantable cardioverter-defibrillator shocks (HR: 0.60; P<0.001). In contrast, a high score was directly correlated with mortality risk (HR: 1.92; P<0.001) and the risk of HF or death (HR: 1.60; P<0.001). Consistently, each 1-U increment in CHA2DS2-VASc was associated with a significant 13{\%} (P=0.003) reduction in VTA risk but a corresponding 33{\%} (P<0.001) increase in mortality risk. Patients with a high CHA2DS2-VASc score and left bundle-branch block derived a pronounced 53{\%} (P<0.001) reduction in the risk of HF or death with cardiac resynchronization therapy with defibrillator versus implantable cardioverter-defibrillator-only therapy. Conclusions Our findings suggest that a high CHA2DS2-VASc score can be used to identify patients with mild HF who have low VTA risk and high morbidity or mortality risk and may derive a pronounced clinical benefit from cardiac resynchronization therapy without a defibrillator. These data suggest a possible role for the CHA2DS2-VASc score in device selection among candidates for biventricular pacing.",
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T1 - CHA2DS2-VASc Score and the Risk of Ventricular Tachyarrhythmic Events and Mortality in MADIT-CRT

AU - Nof, Eyal

AU - Kutyifa, Valentina

AU - McNitt, Scott

AU - Goldberger, Jeffrey

AU - Huang, David

AU - Aktas, Mehmet K.

AU - Spencer, Rosero

AU - Goldenberg, Ilan

AU - Beinart, Roy

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N2 - Background We hypothesized that multiple cardiovascular comorbidities, incorporated in the CHA2DS2-VASc score, may be useful in the assessment of ventricular tachyarrhythmias (VTAs) and mortality risk in heart failure (HF) patients. Methods and Results We evaluated the association between the CHA2DS2-VASc score (dichotomized as high at the upper quartile [≥5] and further assessed as a continuous measure) and the risk of VTA and death among 1804 patients enrolled in MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy). A high CHA2DS2-VASc score (n=464; 26%) was inversely associated with the risk of any VTA (hazard ratio [HR]: 0.64; P=0.001), fast VTA >200 beats/min (HR; 0.51; P<0.001), and appropriate implantable cardioverter-defibrillator shocks (HR: 0.60; P<0.001). In contrast, a high score was directly correlated with mortality risk (HR: 1.92; P<0.001) and the risk of HF or death (HR: 1.60; P<0.001). Consistently, each 1-U increment in CHA2DS2-VASc was associated with a significant 13% (P=0.003) reduction in VTA risk but a corresponding 33% (P<0.001) increase in mortality risk. Patients with a high CHA2DS2-VASc score and left bundle-branch block derived a pronounced 53% (P<0.001) reduction in the risk of HF or death with cardiac resynchronization therapy with defibrillator versus implantable cardioverter-defibrillator-only therapy. Conclusions Our findings suggest that a high CHA2DS2-VASc score can be used to identify patients with mild HF who have low VTA risk and high morbidity or mortality risk and may derive a pronounced clinical benefit from cardiac resynchronization therapy without a defibrillator. These data suggest a possible role for the CHA2DS2-VASc score in device selection among candidates for biventricular pacing.

AB - Background We hypothesized that multiple cardiovascular comorbidities, incorporated in the CHA2DS2-VASc score, may be useful in the assessment of ventricular tachyarrhythmias (VTAs) and mortality risk in heart failure (HF) patients. Methods and Results We evaluated the association between the CHA2DS2-VASc score (dichotomized as high at the upper quartile [≥5] and further assessed as a continuous measure) and the risk of VTA and death among 1804 patients enrolled in MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy). A high CHA2DS2-VASc score (n=464; 26%) was inversely associated with the risk of any VTA (hazard ratio [HR]: 0.64; P=0.001), fast VTA >200 beats/min (HR; 0.51; P<0.001), and appropriate implantable cardioverter-defibrillator shocks (HR: 0.60; P<0.001). In contrast, a high score was directly correlated with mortality risk (HR: 1.92; P<0.001) and the risk of HF or death (HR: 1.60; P<0.001). Consistently, each 1-U increment in CHA2DS2-VASc was associated with a significant 13% (P=0.003) reduction in VTA risk but a corresponding 33% (P<0.001) increase in mortality risk. Patients with a high CHA2DS2-VASc score and left bundle-branch block derived a pronounced 53% (P<0.001) reduction in the risk of HF or death with cardiac resynchronization therapy with defibrillator versus implantable cardioverter-defibrillator-only therapy. Conclusions Our findings suggest that a high CHA2DS2-VASc score can be used to identify patients with mild HF who have low VTA risk and high morbidity or mortality risk and may derive a pronounced clinical benefit from cardiac resynchronization therapy without a defibrillator. These data suggest a possible role for the CHA2DS2-VASc score in device selection among candidates for biventricular pacing.

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