Publication: Efficacy of R<inf>2</inf>CHA<inf>2</inf>DS<inf>2</inf>-VA score for predicting thromboembolism in Thai patients with non-valvular atrial fibrillation
Issued Date
2021-12-01
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14712261
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2-s2.0-85119121072
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Mahidol University
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SCOPUS
Bibliographic Citation
BMC Cardiovascular Disorders. Vol.21, No.1 (2021)
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Komsing Methavigul, Poom Sairat, Rungroj Krittayaphong Efficacy of R<inf>2</inf>CHA<inf>2</inf>DS<inf>2</inf>-VA score for predicting thromboembolism in Thai patients with non-valvular atrial fibrillation. BMC Cardiovascular Disorders. Vol.21, No.1 (2021). doi:10.1186/s12872-021-02370-2 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/77482
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Title
Efficacy of R<inf>2</inf>CHA<inf>2</inf>DS<inf>2</inf>-VA score for predicting thromboembolism in Thai patients with non-valvular atrial fibrillation
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Abstract
Background: There is no data specific to the addition of renal dysfunction and age 50–64 years as risk parameters to the CHA2DS2-VA score, which is known as the R2CHA2DS2-VA score, among NVAF patients. Accordingly, the aim of this study was to validate the R2CHA2DS2-VA score for predicting thromboembolism in Thai NVAF patients. Methods: Thai NVAF patients were prospectively enrolled in a nationwide multicenter registry from 27 hospitals during 2014–2020. Each component of the CHA2DS2-VA and R2CHA2DS2-VA scores was scored and recorded. The main outcomes were thromboembolism, including ischemic stroke, transient ischemic attack (TIA), and/or systemic embolism. The annual incidence rate of thromboembolism among patients in each R2CHA2DS2-VA and CHA2DS2-VA risk score category is shown as hazard ratio (HR) and 95% confidence interval (95% CI). The performance of the R2CHA2DS2-VA and CHA2DS2-VA scores was demonstrated using c-statistics. Net reclassification index was calculated. Calibration plat was used to assess agreement between observed probabilities and predicted probabilities of both scoring system. Results: A total of 3402 patients were enrolled during 2014–2020. The average age of patients was 67.38 ± 11.27 years. Of those, 46.9% had renal disease, 30.7% had a history of heart failure, and 17.1% had previous stroke or TIA. The average R2CHA2DS2-VA and CHA2DS2-VA scores were 3.92 ± 1.92 and 2.98 ± 1.43, respectively. Annual thromboembolic risk increased with incremental increase in R2CHA2DS2-VA and CHA2DS2-VA scores. Oral anticoagulants had benefit in stroke prevention in NVAF patients with an R2CHA2DS2-VA score of 2 or more (adjusted HR: 0.630, 95% CI 0.413–0.962, p = 0.032). The c-statistics were 0.630 (95% CI 0.61–0.65) and 0.627 (95% CI 0.61–0.64), for R2CHA2DS2-VA and CHA2DS2-VA scores respectively. NRI was 2.2%. The slope and R2 of the calibration plot were 0.73 and 0.905 for R2CHA2DS2-VA and 0.70 and 0.846 for CHA2DS2-VA score respectively. Conclusions: R2CHA2DS2-VA score was found to be at least as good as CHA2DS2-VA score for predicting thromboembolism in Thai patients with NVAF. Similar to CHA2DS2-VA score, thromboembolism increased with incremental increase in R2CHA2DS2-VA score.