Heart failure with preserved ejection fraction meets atrial fibrillation: Is enhanced inflammasome signaling a major common mechanism leading to these two frequent diseases?

Usefulness of CHADS2, R2CHADS2, and CHA2DS2-VASc scores for predicting incident atrial fibrillation in heart failure with preserved ejection fraction patients

Aims

Coexisting of atrial fibrillation (AF) in patients with heart failure with preserved ejection fraction (HFpEF) could increase the risk of mortality. In this study, we aimed to assess the values of the CHADS2, R2CHADS2, and CHA2DS2‐VASc scores for AF prediction in HFpEF patients.

Methods and results

We performed a retrospective analysis on symptomatic HFpEF patients in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial. Associations of the CHADS2, R2CHADS2, and CHA2DS2‐VASc scores with the risk of incident AF in HFpEF patients without baseline AF (n = 2202) were assessed using the multivariable competing risk regression models. The discriminatory performances of these scores were calculated using the C‐index. During a median follow‐up of 3.3 years, the average incidence of AF was 1.80 per 100 patient‐years in HFpEF patients. When score was analysed as a continuous variable, per 1‐point increase in the CHADS2 (hazard ratio [HR] = 1.42, 95% confidence interval [CI]: 1.20–1.68, C‐index: 0.71), R2CHADS2 (HR = 1.25, 95% CI: 1.10–1.42, C‐index: 0.69), or CHA2DS2‐VASc (HR = 1.30, 95% CI: 1.16–1.46, C‐index: 0.70) scores was associated with an increased risk of incident AF. When score was analysed as a categorical variable, patients with CHADS2 ≥ 3 (HR = 2.62, 95% CI: 1.70–4.04), R2CHADS2 ≥ 3 (HR = 2.55, 95% CI: 1.56–4.17), or CHA2DS2‐VASc ≥ 4 (HR = 2.54, 95% CI: 1.59–4.07) had a higher risk of incident AF compared with the corresponding controls.

Conclusions

Our data first suggest that the CHADS2, R2CHADS2, and CHA2DS2‐VASc scores could predict the risk of incident AF in HFpEF patients with modest predictive abilities.