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

Olaf Kądzioła¹Konrad Stepien^1,2*Alicia del Carmen Yika³Maria Kurek³Natalia Kachnic³Aleksandra Karcińska³Michael Platschek³Zuzanna Wyleciał³Karol Nowak¹Aleksander Siniarski^1,2Jadwiga Nessler^1,2

• ¹John Paul II Hospital, Krakow, Poland
• ²Department of Coronary Disease and Heart Failure, Institute of Cardiology, Jagiellonian University, Kraków, Lesser Poland, Poland
• ³Jagiellonian University Medical College, Kraków, Lesser Poland, Poland

BACKGROUND: The mortality rate in decompensated heart failure (HF) with preserved ejection fraction (HFpEF) remains high. In recent years the prognostic role of CHA₂DS₂-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 CHA₂DS₂-VASc score. METHODS: 261 (22.74%) out of 1148 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 CHA₂DS₂-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 CHA₂DS₂-VASc ≥4 patients. In a long-term follow-up (median 4.3 years), overall mortality was significantly higher in CHA₂DS₂-VASc ≥4 group (P=0.005) and CHA₂DS₂-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 CHA₂DS₂-VASc score raised all-cause mortality risk by 32%. CONCLUSIONS: As has been shown for the first time CHA₂DS₂-VASc score was an independent prognostic parameter in decompensated HFpEF.