Stroke Risk Stratification With CHA2DS2-VASc in Heart Failure Without AF

Close Up of Ecocardiography report (ECG) showing irregular heartbeat
The CHA2DS2-VASc score predicted stroke risk in patients with heart failure with atrial fibrillation.

A retrospective analysis validated the utility of the CHA2DS2-VASc score for its prognostic utility among patients with heart failure (HF). These findings were published in the American Journal of Cardiology.

Data were sourced for this study from the US Veterans Affairs database. Patients (N=54,416) with a discharge diagnosis of HF between 2002 and 2010 were assessed for CHA2DS2-VASc scores and clinical outcomes on the basis of atrial fibrillation (AF) status.

At baseline, individuals with (n=17,481) and without (n=36,935) AF were aged mean 73.4±11.2 and 68.0±11.0 years, 98.4% and 98.1% were men, 65.6% and 57.5% were White, and CHA2DS2-VASc scores were 4.44±1.35 and 4.01±1.40 points, respectively.

Compared with no baseline AF, the presence of AF associated with increased 1-year incidence rates of ischemic stroke (2.7% vs 2.0%), thromboembolism (10.3% vs 7.9%), and death (29.2% vs 26.0%).

Among all patients, increasing CHA2DS2-VASc scores positively correlated with incidence rates of ischemic stroke from 0.7% (CHA2DS2-VASc =1) to 4.1% (CHA2DS2-VASc ³6), thromboembolism from 2.0% to 15.3%, and death from 15.5% to 39.8%.

Results from this study, compared with previously published data, found the CHA2DS2-VASc score similarly predicted the 1-year incidence rates of ischemic stroke (C, 0.62 vs 0.59), thromboembolism (C, 0.63 vs 0.60), and death (C, 0.60 vs 0.58).

The negative predictive value (NPV) of the CHA2DS2-VASc score for 1-year risk for ischemic stroke was 85.4% (95% CI, 83.4%-87.4%), thromboembolism was 84.6% (95% CI, 82.6%-86.6%), and death was 85.8% (95% CI, 83.9%-87.8%) among patients without AF. Among patients with AF, the NPV was 86.4% (95% CI, 82.6%-90.2%) for ischemic stroke, 85.4% (95% CI, 81.5%-89.4%) for thromboembolism, and 87.1% (95% CI, 83.3%-90.8%) for death.

The predictive power for mortality risk using CHA2DS2-VASc scores decreased at 5 years for both the patients without AF (NPV, 62.2%; 95% CI, 59.5%-64.9%) and with AF (NPV, 49.5%; 95% CI, 43.9%-55.1%). Other 5-year predictors remained ³73.5% NPV.

One limitation of this study was that it did not include patients who were not hospitalized for HF symptoms.

These findings confirm previous research which described the utility for predicting clinical outcomes among patients with HF using the CHA2DS2-VASc score.


Marzouka GR, Rivner H, Mehta V, et al. The CHA2DS2-VASc Score for Risk Stratification of Stroke in Heart Failure With-vs-Without Atrial Fibrillation. Am J Cardiol. 2021;155:72-77. doi:10.1016/j.amjcard.2021.05.004