TY - JOUR

T1 - Thromboembolic risk stratification of patients hospitalized with heart failure in sinus rhythm

T2 - a nationwide cohort study

AU - Wolsk, Emil

AU - Lamberts, Morten

AU - L. Hansen, Morten

AU - Blanche, Paul

AU - Køber, Lars

AU - Torp-Pedersen, Christian

AU - Lip, Gregory Y. H.

AU - Gislason, Gunnar

N1 - © 2015 The Authors. European Journal of Heart Failure © 2015 European Society of Cardiology.

PY - 2015/8

Y1 - 2015/8

N2 - AIMS: Patients with heart failure in sinus rhythm are at an increased risk of thromboembolic complications. So far, validated risk stratification tools are lacking for such patients, which makes the decision to initiate anti-thrombotic treatment difficult.METHODS AND RESULTS: We included 136,545 patients admitted with heart failure in sinus rhythm from national registries from 1999 to 2012. Patients receiving oral anticoagulants were omitted from the study. First, we investigated if the CHA2DS2-VASc score could identify heart failure patients in sinus rhythm with high rates of thromboembolic complications. Second, we investigated if any single CHA2DS2-VASc risk factor carried a greater prognostic value with regard to thromboembolism. The risk of thromboembolism increased more than ninefold (hazard ratio 9.2, 95% confidence interval 6.8-12.5) in patients with all CHA2DS2-VASc risk factors compared with those with heart failure alone. The incidence rates of thromboembolism were clinically significant, averaging 6.0 (95% confidence interval 5.98-6.02) events per 100 patient years during the first year following diagnosis. Risk factors such as diabetes, age, vascular disease, and especially previous thromboembolism, conferred an independent risk of future thromboembolism.CONCLUSION: The CHA2DS2-VASc risk stratification scheme was able to provide prognostic information on future thromboembolic events in patients with heart failure in sinus rhythm. The CHA2DS2-VASc scale could be easily implemented as an aid to clinicians in risk stratifying heart failure patients in sinus rhythm, for thromboembolism.

AB - AIMS: Patients with heart failure in sinus rhythm are at an increased risk of thromboembolic complications. So far, validated risk stratification tools are lacking for such patients, which makes the decision to initiate anti-thrombotic treatment difficult.METHODS AND RESULTS: We included 136,545 patients admitted with heart failure in sinus rhythm from national registries from 1999 to 2012. Patients receiving oral anticoagulants were omitted from the study. First, we investigated if the CHA2DS2-VASc score could identify heart failure patients in sinus rhythm with high rates of thromboembolic complications. Second, we investigated if any single CHA2DS2-VASc risk factor carried a greater prognostic value with regard to thromboembolism. The risk of thromboembolism increased more than ninefold (hazard ratio 9.2, 95% confidence interval 6.8-12.5) in patients with all CHA2DS2-VASc risk factors compared with those with heart failure alone. The incidence rates of thromboembolism were clinically significant, averaging 6.0 (95% confidence interval 5.98-6.02) events per 100 patient years during the first year following diagnosis. Risk factors such as diabetes, age, vascular disease, and especially previous thromboembolism, conferred an independent risk of future thromboembolism.CONCLUSION: The CHA2DS2-VASc risk stratification scheme was able to provide prognostic information on future thromboembolic events in patients with heart failure in sinus rhythm. The CHA2DS2-VASc scale could be easily implemented as an aid to clinicians in risk stratifying heart failure patients in sinus rhythm, for thromboembolism.

KW - Age Factors

KW - Aged

KW - Aged, 80 and over

KW - Cohort Studies

KW - Diabetes Complications

KW - Female

KW - Forecasting

KW - Heart Failure

KW - Hospitalization

KW - Humans

KW - Hypertension

KW - Male

KW - Middle Aged

KW - Prognosis

KW - Risk

KW - Risk Factors

KW - Sex Factors

KW - Thromboembolism

KW - Vascular Diseases

U2 - 10.1002/ejhf.309

DO - 10.1002/ejhf.309

M3 - Journal article

C2 - 26136386

VL - 17

SP - 828

EP - 836

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

SN - 1567-4215

IS - 8

ER -