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Renda G, Ricci F, Patti G, Aung N, Petersen SE, Gallina S, Hamrefors V, Melander O, Sutton R, Engstrom G, Caterina RD, Fedorowski A. CHA2DS2VASc score and adverse outcomes in middle-aged individuals without atrial fibrillation. Eur J Prev Cardiol 2019; 26:1987-1997. [DOI: 10.1177/2047487319868320] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims The CHA2DS2VASc score is used to evaluate the risk of thromboembolic events in patients with non-valvular atrial fibrillation. We assessed the prognostic yield of CHA2DS2VASc for new-onset atrial fibrillation, cardiovascular morbidity and mortality in a non-atrial fibrillation population. Methods We analysed a population-based cohort of 22,179 middle-aged individuals with ( n = 3542) and without ( n = 18,367) a history of atrial fibrillation; we grouped the population into five CHA2DS2VASc strata (0–1–2–3–≥4), and compared the risk of major adverse cerebro-cardiovascular events and mortality. Furthermore, we analysed the annual incidence of atrial fibrillation across different CHA2DS2VASc strata. Results Over a median follow-up of 15 years, 1572 patients (6.9%) had ischaemic strokes, 2162 (9.5%) coronary events and 5899 (26%) died. The cumulative incidence of ischaemic stroke in CHA2DS2VASc ≥ 4 subjects without atrial fibrillation was similar to patients with atrial fibrillation and CHA2DS2VASc 2, with a 10-year crude incidence rate of 0.91 (95% confidence interval (CI) 0.68–1.19) and 1.13 (95% CI 0.93–1.36) ischaemic strokes per 100 patient-years, respectively. CHA2DS2VASc in a non-atrial fibrillation population showed higher predictive accuracy for ischaemic stroke compared with an atrial fibrillation population (area under the curve 0.60 vs. 0.56; P = 0.001). In multivariable Cox regression analysis, CHA2DS2VASc ≥ 2 was an independent predictor of all-cause death (adjusted hazard ratio (aHR) 2.58; 95% CI 2.42–2.76), cardiovascular death (aHR 3.40; 95% CI 2.98–3.89), ischaemic stroke (aHR 2.20; 95% CI 1.92–2.53) and coronary events (aHR 1.83; 95% CI 1.63–2.04). The cumulative incidence of atrial fibrillation was greater with increasing CHA2DS2VASc strata, with an absolute annual incidence of more than 2% per year if CHA2DS2VASc ≥ 4. Conclusion The CHA2DS2VASc score is a sensitive tool for predicting new-onset atrial fibrillation and adverse outcomes in subjects both with and without atrial fibrillation.
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Affiliation(s)
- Giulia Renda
- Institute of Cardiology, Department of Neuroscience, Imaging and Clinical Sciences, and Center of Excellence on Aging, CeSI-Met, G. d'Annunzio University, Chieti-Pescara, Italy
| | - Fabrizio Ricci
- Institute of Advanced Biomedical Technologies, G. d'Annunzio University, Chieti-Pescara, Italy
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Fondazione Villa Serena per la Ricerca, Città Sant'Angelo (PE), Italy
| | | | - Nay Aung
- William Harvey Research Institute, Queen Mary University of London, UK
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Steffen E Petersen
- William Harvey Research Institute, Queen Mary University of London, UK
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Sabina Gallina
- Institute of Cardiology, Department of Neuroscience, Imaging and Clinical Sciences, and Center of Excellence on Aging, CeSI-Met, G. d'Annunzio University, Chieti-Pescara, Italy
- Institute of Advanced Biomedical Technologies, G. d'Annunzio University, Chieti-Pescara, Italy
| | - Viktor Hamrefors
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Richard Sutton
- National Heart and Lung Institute, Hammersmith Hospital Campus, London, UK
| | - Gunnar Engstrom
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | | | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
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Griffin GD. Stroke, mTBI, infection, antibiotics and beta blockade: Connecting the dots. Med Hypotheses 2015; 85:224-9. [PMID: 26045369 DOI: 10.1016/j.mehy.2015.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 04/21/2015] [Accepted: 05/02/2015] [Indexed: 10/23/2022]
Abstract
Several themes supported by a robust literature are addressed in this clinical translational review and research paper: (1) the inadequate standard of care for minimal traumatic brain injury (mTBI)/concussion when compared to stroke because diagnosis and care for mTBI/concussion are based primarily on a symptom only framework; (2) the treatment of stroke (brain injury) infection with select antibiotics; (3) the use of beta blockade in stroke (brain injury). The various etiologies of brain injury appear to coalesce to common endpoints: potential neuronal demise, cognitive and functional losses, immune suppression and infection. The use of principles patterned after 'Koch's Postulates' (show/prove the presence of infection/illness/disease, treat until resolved, and prove objectively that the disease/illness is gone/healed/cured) appears to be marginalized in establishing a diagnosis and recovery from mTBI/TBI. The pathways of immune system interactions in stroke (brain injury) and infection are briefly discussed. The suggestion of combined specific antibiotic and beta blockade for ischemic stroke (brain injury) and mTBI is advanced for treatment and expeditious further study. Stroke is considered a brain injury in this paper. Stroke is also considered and recommended as a study model for mTBI therapy because of their common end points from brain damage. It is suggested that potential transfer or translation of therapy for stroke may be useful in mTBI.
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