Does the CHA2DS2-VASc score reliably predict atrial arrhythmias? Analysis of a nationwide database of remote monitoring data transmitted daily from cardiac implantable electronic devices

Giovanni Rovaris, Francesco Solimene, Antonio D'Onofrio, Gabriele Zanotto, Renato P. Ricci, Tiziana Mazzella, Saverio Iacopino, Paolo Della Bella, Giampiero Maglia, Gaetano Senatore, Fabio Quartieri, Mauro Biffi, Antonio Curnis, Valeria Calvi, Antonio Rapacciuolo, Matteo Santamaria, Alessandro Capucci, Massimo Giammaria, Andrea Campana, Fabrizio CaravatiDaniele Giacopelli, Alessio Gargaro, Ennio C. Pisanò

Research output: Contribution to journalArticle

Abstract

Background: CHA2DS2-VASc is a validated score for predicting stroke in patients with atrial fibrillation (AF). Objective: The purpose of this study was to assess whether the CHA2DS2-VASc score can predict new-onset AF in a cohort of patients with a cardiac implantable electronic device (CIED) followed with remote monitoring. Methods: Using the database of the Home Monitoring Expert Alliance project, we selected 2410 patients with no documented AF who had received a CIED with diagnostics on atrial high rate episodes (AHREs). The primary endpoint was time to first day with cumulative AHRE burden ≥15 minutes, 5 hours, 24 hours, and ≥7 consecutive days. Results: During a median duration of 24.1(11.5–42.9) months, the incidence of AHRE increased with increasing CHA2DS2-VASc. At 6 years, occurrence of ≥15-minute AHRE was 80.2% (CHA2DS2-VASc ≤1) vs 93.7% (CHA2DS2-VASc ≥5), whereas ≥5-hour AHRE incidence was 68.4% (CHA2DS2-VASc ≤1) vs 92.5% (CHA2DS2-VASc ≥5). Occurrence of ≥24-hour and ≥7-day AHREs also increased with increasing CHA2DS2-VASc: 9.1% and 3.9% (CHA2DS2-VASc ≤1) vs 40.4% and 28.7% (CHA2DS2-VASc ≥5), respectively. Adjusted hazard ratio for unitary CHA2DS2-VASc increase ranged from 1.09 (confidence interval 1.04–1.14; P <.001) with AHRE burden ≥15 minutes to 1.26 (confidence interval 1.11–1.42; P <.001) with AHRE burden ≥7 days. At receiver operating curve analysis, CHA2DS2-VASc ≥2 was estimated to predict persistent forms of AHREs with 95.8% sensitivity but 11.7% specificity at 3 years. CHA2DS2-VASc ≥5 had 77.0% specificity but 34.6% sensitivity. Conclusion: In a CIED population with no previous diagnosis of clinical AF, AHRE incidence increased with increasing CHA2DS2-VASc score. The association was stronger with longer AHREs, but the accuracy of CHA2DS2-VASc as AHRE predictor was moderate.

Original languageEnglish
Pages (from-to)971-979
Number of pages9
JournalHeart Rhythm
Volume15
Issue number7
DOIs
Publication statusPublished - Jul 1 2018

Keywords

  • Atrial fibrillation
  • Cardiac implantable electronic device
  • CHADS-VASc score
  • Clinical predictor
  • Remote monitoring

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Rovaris, G., Solimene, F., D'Onofrio, A., Zanotto, G., Ricci, R. P., Mazzella, T., Iacopino, S., Della Bella, P., Maglia, G., Senatore, G., Quartieri, F., Biffi, M., Curnis, A., Calvi, V., Rapacciuolo, A., Santamaria, M., Capucci, A., Giammaria, M., Campana, A., ... Pisanò, E. C. (2018). Does the CHA2DS2-VASc score reliably predict atrial arrhythmias? Analysis of a nationwide database of remote monitoring data transmitted daily from cardiac implantable electronic devices. Heart Rhythm, 15(7), 971-979. https://doi.org/10.1016/j.hrthm.2018.02.023