Comparison of the Prognostic Value Between CHA2DS2-VASc and R2CHA2DS2-VASc Scores in Patients With Atrial Fibrillation and Heart Failure
10.3969/j.issn.1000-3614.2025.07.006
- VernacularTitle:CHA2DS2-VASc评分与R2CHA2DS2-VASc评分对心房颤动合并心力衰竭患者预后的预测价值
- Author:
Yile LIN
1
;
Shuyan ZHANG
;
Zeyue CHEN
;
Zhiyu HE
;
Dunzheng HAN
;
Haobin ZHOU
;
Hongliang XUE
;
MOK TOI-MENG
;
Chen LIU
;
Woliang YUAN
;
Yugang DONG
;
Ailan CHEN
Author Information
1. 中山大学孙逸仙纪念医院深汕中心医院 心内科,汕尾 516621;广州医科大学附属第一医院 心内科,广州 510163
- Publication Type:Journal Article
- Keywords:
heart failure;
atrial fibrillation;
CHA2DS2-VASc score;
R2CHA2DS2-VASc score
- From:
Chinese Circulation Journal
2025;40(7):674-680
- CountryChina
- Language:Chinese
-
Abstract:
Objectives:To investigate the prognostic value of the CHA2DS2-VASc and R2CHA2DS2-VASc scores in patients with atrial fibrillation(AF)and heart failure(HF).Methods:Patients with AF and HF from hospitals diagnosed by the Heart Failure Center in Guangdong Province between January 2017 and December 2021 were selected.Major adverse cardiovascular events(MACE)were used as the follow-up endpoint.Statistical methods such as the area under the receiver operating characteristic(ROC)curve(AUC),net reclassification index(NRI),and integrated discrimination improvement(IDI)were applied to evaluate the predictive value of the CHA2DS2-VASc and R2CHA2DS2-VASc scores in patients with AF and HF.Results:A total of 1 839 patients were enrolled in this study,comprising 703 patients in the MACE group and 1 136 patients in the non-MACE group.Compared with the non-MACE group,the MACE group exhibited significantly advanced age,higher prevalence of New York Heart Association class Ⅳ and coronary artery disease,lower diastolic blood pressure and estimated glomerular filtration rate levels,and elevated serum N-terminal pro-B-type natriuretic peptide concentrations(all P<0.05).Additionally,significantly lower proportions of patients in the MACE group received angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors,beta-blockers,mineralocorticoid receptor antagonists,or anticoagulant therapy(all P<0.05).Multivariable logistic regression analysis revealed that each 1-point increment in both CHA2DS2-VASc and R2CHA2DS2-VASc scores was associated with approximately 10%increased risk of MACE.ROC curve analysis demonstrated that the AUC values for predicting MACE in AF patients with HF were 0.555(95%CI:0.528-0.582,P<0.001)for CHA2DS2-VASc and 0.576(95%CI:0.549-0.608,P<0.001)for R2CHA2DS2-VASc,indicating marginally superior discriminatory capacity of the R2CHA2DS2-VASc score.Delong's test confirmed statistically significant differences between the two scoring systems(P=0.001).The R2CHA2DS2-VASc score demonstrated a NRI of 0.259(95%CI:0.166-0.352,P<0.001)and an IDI of 0.007(95%CI:0.005-0.010,P<0.001)compared with the conventional CHA2DS2-VASc score.Although the R2CHA2DS2-VASc score exhibited slightly better predictive accuracy and outcome discrimination capacity than the original scoring system,both scores demonstrated suboptimal clinical predictive performance.Conclusions:Both the R2CHA2DS2-VASc and CHA2DS2-VASc scores show suboptimal performance for predicting the risk of MACE in patients with AF and HF,and the predicting performance of R2CHA2DS2-VASc score is marginally superior to CHA2DS2-VASc score in this patient cohort.
